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ARCHIVED REPORTS XR0000665
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 XR0000665
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Entry Properties
Last modified
2/15/2019 9:44:01 PM
Creation date
2/15/2019 3:16:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000665
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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0 • CHAIN OF CUSTOAEC RD <br /> ( Advanced <br /> -- GeoEnvironmental, Inc. Date r (j'c Page of <br /> 637 Shaw Road-Stockton, California 95215 - (203)467-1006 - Fax (209)467-1118 <br /> ClientProject Manager <br /> Tests Required <br /> Phone Nu ber <br /> �, L-1(6-7_ (OC) <br /> Samplers (Signature) Invoice <br /> Project Name) r�; � AGE <br /> Client ❑ <br /> Sample Location Sample Type <br /> Date TimeWater Solid No of Nates <br /> Number Description Crimp Grab Air Cons "" <br /> W Z Sze -- X <br /> LA <br /> AWE OA VV ly��' � � X <br /> AWWg� lel S <br /> i Received y (Signature) Datef ime <br /> R ed by (Signature) Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for(laid analysis (Signature) DatelTime <br /> C � <br /> Dispatched by (Signature) dale/Time a or Laboratory by ID te/Time <br /> iso 161s— <br /> Method of Shipment � Laboratory Name <br /> Spectai tnsltuclions ► 4 i I he authorize the a anc of thea ve indlcated work <br /> I�`l} <br />
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