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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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• <br /> ( Advanced CHAIN OF CU ODY RECORD <br /> �� <br /> GeoEnv>ronmcntal, Inc. ap l 5 Date Page of <br /> 4005 Nodh Wilson Way Slockton,Galrtomia 95205-(209)467-1006 Fax(209)467-1118 <br /> Qient F Pu ct <br /> Project Manage,. Test `equired <br /> 1lt�a'l CL�� <br /> Phone Number <br /> 2� A, 11V <br /> Samplers (Sq <br /> gnatire) \ Invoice <br /> 0 p <br /> Protect NameA 1�� AGE <br /> r� CC 71/// Client <br /> G nt ❑ <br /> Sample Locati0 Sample Type No of <br /> Number Description Date Time Water Air Solid Conts �� Notes <br /> Comp Grab <br /> 0 3Z 4 s 5 3752 <br /> D- 2 7— S i !( ' 17 v 3752 <br /> /p 3 75 3 <br /> t I /s� P 3o 1 K 37531 <br /> � � 3753 <br /> �x Id <br /> Z 7—RI Jt AL 17 � �`''�s 37533 <br /> P 2-Y - S� V <br /> 37534 <br /> 9 inquis ed4y ig ature) eceive y (signature) r Date/Tlme <br /> Rolrnq lied by (Signature) Ilecorved by (Signature) DalefTlme <br /> naiinquished by (Signature) neceived by Mobile Laboratory lot field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Dale/Time n ce ed for Laboratory by Date/Time <br /> trr-ifp <br /> Method of ShipmentCr MrRV <br /> ,, Laboratory Name <br /> Speclallnstructions I hereby authorize the perform ce at the above Indicated work <br /> LRC1 LrJ f iUe <br /> 1 <br />
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