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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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CHAIN.OF Advanced O CU QDY RECORD <br /> GeoEnviront�ental, Inc. �� ��� - �o G Date OS D od Page of <br /> �.J 4 North orih Wilson Way-Stockton,Calitomia 95205-(209)457-5008-Fax(209)467 1 118 <br /> Client Ftp, Cl.h Project Manager <br /> r Tests Required IM ( 012-114A <br /> Phone Number I <br /> Samplers (Signature �� (� y Invoice <br /> Project Name �j �4�` AGE . <br /> E ! �v Client ❑ <br /> Sample Location Sample Type No of J Q <br /> Number Description Date Time Water Air Solid Cents 'V Notes <br /> Comp Grab + <br /> r� _37406 <br /> -37.487 <br /> 1-3 A i r <br /> P-t -vel :5v 4 tJohS r _ J 7-9 0 <br /> f-(q -S � °I�Zo j�jQ--,W <br /> I _37491_ <br /> k, 37492 <br /> guts eLh�� <br /> ature) statue y tgnature uatertrme <br /> Rchnq lied by (Signatuie) Received by (Signature) Datefflme <br /> Relinquished by (Signalute) Recurved by Mobile laboratory tot field analysis (Signature) Date/Time <br /> Dispatched by (Signature) "" Date/TimeR ved for Laboratory by g ! DatetTlme <br /> MA <br /> Method of Shipment t+L/l —_._ ..-- ��'C�FI�;*��1� i L !L borala y Na <br /> {/����iU��]] l (.� l.. <br /> Ei 'special Instructions I I't-11D SPAGE A" LN I hereby authorize the perror anew or the above Indicated work <br /> -� V <br />
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