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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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i <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc. () Dat /b �D Page or-- ! <br /> 4005 Norlh Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> r <br /> Client Project Manager <br /> `WW e /M� Tests Required <br /> Phone Number ry, <br /> 2_0 <br /> Samplers (Signatw ) 4 Invoice <br /> d / <br /> Project Name L/ �t , Y AGE, <br /> Client ❑ <br /> Sample Location Sample Type <br /> D Time Water Air Solid Con sNo oi XV 'y Notes <br /> Number Description i <br /> Comp Grab <br /> P-2'Z —/0r ;+ 37507 <br /> o 3� i� <br /> 37508 <br /> k IZ`53r 37509 <br /> r� <br /> 2Z—!� lz;SB V0A 37510 <br /> 37511 <br /> ` <br /> (0 / t 37512 <br /> 37513 <br /> _A urs e ( ign tire) eceive y (Signature) alerrlme <br /> Rnl 1 had y (Sr nature ' D �� .r0� <br /> g ) Received by (Signalure) DalelTime <br /> Relmqu+shed by (Srgnaiure) Received by Mobile Laboratory for held analysis (Signature) Date(Time <br /> Dispatched by (Signature) V Dale/Tlm c Ived for Laboratory by DatafTlme <br /> 11'r-TAIrIoNd ..0;/it G.3 <br /> Method of Shipment1CFJ l i M-w. boralo y Name /),1r r 4 � <br /> ON <br /> Special Instructions 1i�r�O5i�CEF�5��i3T w GofjfAlp,i�1s�...��.,, I hereby authorize the perform ce of the above Indicated work <br />
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