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ARCHIVED REPORTS XR0000667
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 XR0000667
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Entry Properties
Last modified
2/15/2019 10:16:01 PM
Creation date
2/15/2019 3:18:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000667
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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..�... 11 i♦ (♦ i♦ l♦ (♦ i♦ <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnv�ronmental, Inc. <br /> Date 3-2-2-41 '1 Page Z of F <br /> 837 Shaw Road Stockton, California 95215- (209)467-1006- Fax (209)467-1 Iia <br /> Client R 0 K 1 <br /> 4e-s Protect manager <br /> Lie [14 r Tests Required <br /> Phone Number <br /> Samplers (Signature) <br /> i Prosect Name i Invoice <br /> AGES <br /> t u f 0.ti <br /> Sample Location Sam p Type Client C3 <br /> Number Description Date Time Water Solid No of <br /> Comp drab r�)r Conts r Notes <br /> 1 , <br /> �y 03Ai-0-3 l5s7Z <br /> �`t iaI)L�(o3 1 1 <br /> CL-10 a3 �a�3 fly - <br /> � 1 <br /> is e y ( +gnat ry ` <br /> ace ve y +gnature <br /> by <br /> Date/Time <br /> efinquished (S+gnature) 17 ime <br /> Received by (Signature) <br /> Datelrims <br /> Rel+nqurahed by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Dispatched by (Signature) Catemnis <br /> Recaiv r aboratory b Date/time <br /> Da e/Time <br /> Method of Shipment C <br /> a l a v Labor ry Name <br /> Spectat Instructionser <br /> M <br /> I hereby thorize the perf rmance of the above indicated work <br />
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