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ARCHIVED REPORTS XR0000669
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 XR0000669
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Entry Properties
Last modified
2/15/2019 6:24:49 PM
Creation date
2/15/2019 3:19:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000669
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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a <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeciEnvironmental, Inc 3 r ' '� Date I Page --� Of <br /> 837 Shaw Road-Stockton, California- 95215 - (209) 467-1006- Fax (209) 467-1118 <br /> Client an�er Tests Required <br /> 4 <br /> hone NN p bei <br /> Sam (Signat4re) Invoice, <br /> Project Name X AGE <br /> l' _K Client ❑ <br /> Sample Location Sample Type <br /> Number Desorption <br /> Date Time Water Air Solid No C n sf Notes <br /> r4 __ Comp Grab <br /> Ir,.b` 3siTY.�IJ I.A I' rLD D1 �' -- <br /> e m e ( i et a <br /> Received y (Signature) te/Time <br /> ,7/ <br /> Reiinqu a ed by (SIgnature) Received by (Signature) DatSI fZ� � e �e <br />� elTlme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Re4�iv�A�r aboratov, D telTima <br /> 11 V <br /> Method of Shlprne Labor' <br /> i r <br /> speclal Instruct+ons LlI hereby au orize a perfor ante of the 6ove Indicated work <br />
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