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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 CHAIN OF CUSTODY RECORD <br /> GcoEnvironmental, Inc -7_0fir, ?jam 7 ��� Date Page Of <br /> 4005 North Wlloon Way Stockton,California 95205-(209)4671006-Fax(209)467-1110 <br /> rr <br /> Client Project Manag <br /> Tests Required <br /> a <br /> Phone Number <br /> a :irs (S gnature) lrwfolce 0 <br /> Protect Name . 1, f AGE of <br /> TT g ( ii/t Client ❑ <br /> ample Type � � <br /> Sample Location Date TimeNa of <br /> Number Description Water Solid Air Conts I Notes <br /> Comp Orab <br /> J' r a <br /> 417'58 N <br /> 1759 <br /> 41769 N <br /> (M 1 <br /> +41761 <br /> YAW <br /> It q A10 1.41 41762 <br /> r <br /> L/ t1 r` o 14 x 41763 ` <br /> 1 <br /> 41764 0 <br /> e a y rg nlure Mace ve y (Signature) <br /> ei Caw U3()/n (7 <br /> Reilliquished by (STgnetura (17 <br /> Recelved by (Signature) Dalefflme v <br /> nal,n4ulshed by (51g re) n^ �r r _ ,r Received by Miabile Laboratory for field analysis (Signature) Dale/Tine <br /> Dispalchid by (5,gnatury) Or Date/Tirr,a Received for Laboratory by Dala/Time <br /> L .4 1 <br /> I.A 1."—r i,I �JG. tr,�,i-I13 <br /> Mwlhod of Shipment Laboratory Nsm <br /> �rr/7- <br /> Special r ! herebysuch rze ! e pert rm oe of the above Indicated work N <br /> Cn <br />
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