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ARCHIVED REPORTS XR0000648
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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CAPITOL
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6421
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2900 - Site Mitigation Program
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PR0522496
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ARCHIVED REPORTS XR0000648
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Entry Properties
Last modified
2/15/2019 9:28:37 PM
Creation date
2/15/2019 3:09:00 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000648
RECORD_ID
PR0522496
PE
2957
FACILITY_ID
FA0015317
FACILITY_NAME
FLAG CITY CHEVRON
STREET_NUMBER
6421
STREET_NAME
CAPITOL
STREET_TYPE
AVE
City
LODI
Zip
95245
APN
05532024
CURRENT_STATUS
02
SITE_LOCATION
6421 CAPITOL AVE
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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c)5�1231 <br /> Advanced CHAIN OF CUSTODAECORD <br /> � <br /> GcoEnvironmental, Inc. Date 1 05 Page --L Of� <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467 1006- Fax (209)467-1118 <br /> Client project Martager } Tests Required <br /> Phone Number <br /> Samplers (StgrTtune) Invoice <br /> AGE,W' <br /> Project Name -� Client ❑ <br /> Sample Type <br /> Sample Location nate Time Solid No of �� Notes <br /> Number Description compVateGrab Air Conts <br /> � EW <br /> 0) EU) <br /> W "3z� <br /> — `f Da (Time <br /> e inquis e y r ture) ece ve y rgnaWre � * <br /> - <br /> 1 Datellim <br /> RelinquFshed by (Signature) Received by (Signature) <br /> Hx <br /> Relinquished by (Signature) Received by Mobile Laboratory for fieid analysis (Signature) DatelTime <br /> Dispatched by (Signature) <br /> DatelTime deceived for Laboratory by Date(fime <br /> Laboratory Name <br /> Method of Shipment 1cwto Alai <br /> GOOD COi)1iTt7 <br /> TETE hereby authorize the erformance of the bove I aced work <br /> Special Instructions A f FED <br /> F �/ pE T D IM w� SERVED TN Ig a <br />
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