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ARCHIVED REPORTS XR0000659
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 XR0000659
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Entry Properties
Last modified
2/15/2019 9:22:49 PM
Creation date
2/15/2019 3:11:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000659
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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WNg
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EHD - Public
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i <br /> { Advanced CHAIN OF CUSTODY RECORD <br /> -- GeciEnvlronmentai, Inc. :2_k0 ,�� Dates-1 � Page TL_ of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1008-F"09)467-1118 <br /> ClientG' Project Manager Tests Required <br /> , ) <br /> Phone Number <br /> L-zorD 4 4;7-1 bd ' <br /> Samplers (Signature) Invoice <br /> Project NamerLA9 AGE <br /> 01� Client ❑ <br /> Sample Type <br /> Sample Location No of <br /> Number Description Date Time Water Comp Drab Air Solid No <br /> 42944 <br /> Nates <br /> einquis e y ignature Received by gnatura Daternme <br /> {eco l34r5 <br /> Relin 1s ed by (Signature) t{�st� i r9 lgc9!Yp$ky (Signature) date/Time -- <br /> { <br /> 35 <br /> !ftfteishe y (Signatur t ( ,� &Wv%W hy-Mobile Laboratory for field analysis (Signature) ll <br /> 4� DstelTlme <br /> did S� <br /> ��r S <br /> Eaisp)¢he by (S+gnatur //ts c Date/Time Redei%Td for Laboratory,by Date/Time <br /> 7JI4 <br /> ' 1 fJrr "1 <br /> Method of Shipment Lab'o tory Name <br /> Spaciati tnstlucttons i hereby authorize,lthe performance of the above indicated work <br /> D �ci� (V tJc .�-�-e ' <br />
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