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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 <br /> Advanced CHAIN F C STODY RECORD <br /> GeoEnvironmental, Inc Date !q t7 Kase � of <br /> 837 Shaw Road -Stockton, California- 95215 - (209) 467 1006 - Fax (209)467-1118 <br /> Client 1 Protect Manaj� <br /> Tests Required <br /> 04 -11 <br /> P�hone Numbe <br /> 7 <br /> ja�drs (Signature) Invoice <br /> Project Name ti AGE <br /> Client <br /> Sample Type ! <br /> Sample Location Solid No of <br /> Number Description Date Time Water Air Conts Notes <br /> Comp Grab <br /> 2 �- <br /> � -- l <br /> V-71 ;4 iF� <br /> e m us e i not re <br /> q 9 ece ve y�ignature) Qle/Time <br /> F "Ala— f � -� <br /> Relinquished by (Signature) Received by (Signature) Qate/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) � QatelTime <br /> Dispatched by (Signature) Date1T(ma Re �yLaabbo�ratory b Bat lYrms <br /> Method of Shipment <br /> F 0 rs _ Laborat Nam <br /> Special instructions <br /> �C � A � � I hereby auth a the a rman a of the above indicated work <br /> Ir C r� <br />
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