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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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Advanced CHAIN OF CUSTODY RECORD <br /> -' � <br /> GeoEnvironmental, Inc. Date Page <br /> 837 Shaw Road-Stockton, California-95215- (209)467 1006- Fax (209)467-1118 <br /> Client Prolpet Mana <br /> 'ITI� Tests Required <br /> Phone Number <br /> '0 m <br /> a ers (S ature) Invoice <br /> Project Nance AGE <br /> l Client EJ <br /> Sample Locat n Sample Type <br /> Date Tme Water Air Solid Conts Notes <br /> No of <br /> Number Description � <br /> Comp Grab <br /> -� A4,W 6 Ao <br /> ILe rnquis y nature ecerve by gnat re <br /> Da lTrme <br /> r�� <br /> Relinquished by Stgnature) Received by (Signature) at /Trina <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTune <br /> Dispatched by (Signature) Dale/Time Pec o boratory by at /TEM <br /> �s� <br /> Method of Shipment Labo►ato0 e <br /> r <br /> r <br /> Special Instructions }CEJt* `— TTe"r Ny au Pike the riormance of the above indicated work <br /> GOOD CONDITION !tROPRIATE <br /> f <br /> DECilLORiNArL IN LAB PRESERVED IN LAB <br /> WAS 0&0 MBTALS i 11MIER <br /> PRCSRRVATTON %,"' I i &- <br />
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