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ARCHIVED REPORTS XR0000684
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 XR0000684
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Entry Properties
Last modified
2/15/2019 10:31:29 PM
Creation date
2/15/2019 4:02:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000684
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
Scanner
WNg
Tags
EHD - Public
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• r • <br /> CHAIN OF CUSTODY RECORD <br /> ( Advanced Pa t C4 <br /> _ GeoEnvironmental, Inc. � �*��L <br /> +/ 637 Shaw Road-Stockton, flalllornla B5215-(209)467-1 DD6- Fax (209) 467-1118 <br /> Client ' Pra ct Manage T s Required <br /> t lv� r• <br /> Ph 0IV ber <br /> 416-7 z6v <br /> Sa lers, (Signature) Invoice <br /> J AGE <br /> Project Name � - r�(�`J C[lent <br /> Sample Type No of 6 <br /> Sample Location Date Time Water Solid Notes <br /> Number Description Comp Grob Air Cortts <br /> Relinqui3hed by ignature scans y gnatu►a <br /> atell'ima <br /> �1L <br /> Date/ilme <br /> Relinquished by (&gnaturs) Received by (5lgnatvra) <br /> Relinqu shed by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> DatalT ima <br /> Datelfime <br /> Dispatohed by (Signature) <br /> Date rima Receive lorLaboratoryb <br /> Labor or Name � <br /> Method of Shipment <br /> i hereby authorize the Derlormanoe of the above Indicated work <br /> Special instructions <br /> r� <br /> Project 2 89 Page 12 of 12 <br />
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