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ARCHIVED REPORTS XR0000689
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 XR0000689
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Entry Properties
Last modified
2/15/2019 9:44:24 PM
Creation date
2/15/2019 4:07:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000689
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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-1-) 0 16911 CHAIN OF CUST* RECORD <br /> Advanced <br /> GcoEnvnonmental, hic Date "� Page of <br /> J 4005 North Wilson Way Slocklon California 95205 (209)467 1006 Fax(209)467 11 it; <br /> Client Project Manager <br /> v r•> ?Tests <br /> _ Required <br /> C-Q <br /> Phone Number o+y^ <br /> Samplers (Signature) . Invoice <br /> AGE <br /> Project Name + fir t t / 1 ��� Client ON <br /> t <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts X14 �( � Notes <br /> Comp Grab <br /> T" Gr,� No - 1 3 wmtt r1 VAoAIS <br /> -Is 54 Uf"t"W75 t �x� -00 I.L <br /> PFJ <br /> _(-I o x l O~ <br /> t� at r! r 1 r1 ^U3 <br /> 13 - -75 Tr 7� L� HCl 73 :c 7l� 4 -q-QD 0 STS <br /> To <br /> ` -r- Itjr.Mr e1�r tV . -15 ! WCC l-Q r <br /> 1 C� 4 I15.1 <br /> 1 r i,n� L �J V /+ <br /> - r <br /> -- ti,. t r <br /> c_r+. "r rrr` .� •Gr l .r7U 'K <br /> �T ryuis e y ( +gna ure) Receive y (Signature) <br /> Oaf¢/Time <br /> �'' s Tt) ,_,DI -Ap U 5/00IA <br /> 3' 3 <br /> Relinquished by (Signature) Received by (Signature) D le/lrme <br /> Relinquished by (Signature) Rc c, ecMobr c lab tat for held analysis (S, nature) Dale/Time <br /> .,0 <br /> Dispatched by (Signature) ale/Time R car bora ry b Dateffime <br /> L ZL`c� Q-y5ctiw• <br /> Method of Shipment LAbotvfy Name <br /> A ;cc- <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />
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