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ARCHIVED REPORTS XR0000679
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 XR0000679
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Entry Properties
Last modified
2/15/2019 8:22:33 PM
Creation date
2/15/2019 3:51:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000679
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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f Advanced <br /> CHAIN OF CUSTODAECORD <br /> GeoEnvironmental, Inc. Date irS Page _ of <br /> 837Shaw Road -Stockton, Callfornla- 95215 - (209)467-1008 - Fax (209) 467-1118 <br /> ClientProject Manager <br /> 3 g, C,s — Tests Required <br /> t, � <br /> Phone Number <br /> Sa filers (Signature �� Invoice <br /> Project Name j �l � AGE 4Y en 0 <br /> CE <br /> Sample Location Sample ype <br /> No of <br /> Date me Watef Solid N <br /> rimeNotes <br /> Number Description comp Grab Air Conts <br /> qaq Lj X X <br /> � ~� <br /> 7- IZ53 <br /> Z -T X-i (W) <br /> (-(1,,101 1`1 <br /> NV <br /> 1 � , v <br /> die tnquis e y ('signature) (Signature) Date/Time <br /> Roll had by (Signa rel Received by (Signature) Da alTima <br /> r <br /> " - , <br /> Rehnqufshed by Signature) Received by Mobile Laboratory lot field analysts (Signatures DatelTlrne <br /> Dispatched by (Signature) Dateffirne Race v Laboratory Y Data/Tlme <br /> Method of Shipment r Laborato me <br /> r <br /> Special instructions I hereby authorize tile performance of the above Indicated work <br /> r - <br />
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