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ARCHIVED REPORTS XR0000674
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 XR0000674
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Entry Properties
Last modified
2/15/2019 7:32:34 PM
Creation date
2/15/2019 3:34:15 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000674
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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Q 10-7 — I !�- <br /> ( Advanced CHAIN QF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date a age ---L Of <br /> 637 Shaw Road-Stockton,California-95215- (209)467-1006 - Fax (209) 467-111 a <br /> Client Protect Managgir Tests Required <br /> Ut <br />� L'— <br /> one"7, <br /> l.-o( <br /> Sample (Sig ture) Invoice, <br /> Project Name ' AGE <br /> 7at <br /> Client <br /> Sample Location Sample TypeTime Na of <br /> Number Description Water Air Solid Conts Notes <br /> Comp (arab <br /> 1120 3OLLq-m::�L <br /> KXA I I <br /> e inqui Receive y ignature Date rime <br /> -' `� �'� � S0 GSC' <br /> Relinquished by {signature) Rec ved y g fillarrer <br /> D te/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dale(T1me <br /> Dispatched by (Signature) DatelTime Received for Laboratory by DaleMme <br /> Method of Shipment � � / Laborato Name �-- <br /> W <br /> Special ts►stsuctfons �(,�J I hereby authorize th erfor nce of tha above indicated work <br />
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