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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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Advanced h <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvzrozimental, Inc y Date <br /> page of 0 <br /> 005 North Wilson Wary Stockton Cahfornla 95205-(209)467 1006ry Fax(209)467 1110 <br /> m <br /> t3 <br /> Client 1� Project ManagerCr <br /> � "'rM Tests Required <br /> n <br /> Phone Number <br /> � Y <br /> Samplers (Signature) Invoico <br /> 4 c <br /> Protect Name r1A <br /> AGE <br /> �S. ......... .... E�F� <br /> Sample Location Sample Type <br /> Client <br /> Number Description Date Time Water Solid No of <br /> Comp Drab Air Conts I Notes <br /> r <br /> i I''bn� ,.n -*o oras- 10'���" 41671 <br /> Nyle '' #" l�3S }� 416 <br /> r� lob 046' X }< � � 41673 N <br /> �)(1 OrOUB& 1 r' 10 }C <br /> S 41674 <br /> 41675 <br /> ,. <br /> VI <br /> h X x 41677 0 <br /> u' �� y ( neluro <br /> Received y rpnarure r q <br /> _ dzgl a Dele/ti a <br /> 1D cn <br /> rshed by (Signature) <br /> Received by (Signature) <br /> rlale/Time � <br /> n <br /> Relinquished by (5ignalu�e) � <br /> Received by Mobile Laboratory for field anelysls (Slgnalure) <br /> J Date/Tims <br /> D>patchnd by (Slgf4eiur9) Dale/Time CiA <br /> Reserved or aboratory by <br /> DalWime <br /> Method f Shipment <br /> r r I Laboratory Name <br /> �12 La- rAJ� Irl <br /> Special lnslretgonz ro <br /> 7 hero y authorize the performance or 1h above indicated work W <br /> � rn <br />
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