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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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I Advanced CHAIN F USTODY RECO D <br /> "T GeoEnvironmental, Inc. 03 0 34�j Date � Page � � <br /> 837 Shaw Road-Stockton, California-95215- (209)467-1006 Fax(209)467-1118 <br /> Client Pro1w Mane ,i <br /> Tests Required <br /> r I <br /> P ne tuber <br /> X67 <br /> Sam g ature) Invoice <br /> Project Name AGE ❑ <br /> Client ❑ <br /> Sample Location Sample TYPE <br /> Number Description Date Time Water Air Solid Cons Notes <br /> Comp Grab <br /> 135 <br /> -03 13 L1 I <br /> I <br /> PA [Dia -- t � <br /> ) PA � <br /> eitn u eb n re) acetve <br /> y rgnature <br /> 0 e/Time <br /> Relinquished by rSigna,,i e)\ pRS, , f, ec$tve by S� nature) <br /> ��CC'idT1TI0N FaE'':OP"s Date/Time i <br /> Relinquished by (SigRat AWE, ved by Mobile Laboratory for field analysis (Signature) <br /> DatefTime <br /> I <br /> Dispatched by (Signature) Datet rime Received or Laboratory by <br /> atelTimpe <br /> Method of Shipment labors N e <br /> ectal lnstruze <br /> i hereby auth ize the rfor nce of the above indicated work <br /> SLc�/�er 1� �� CD <br />
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