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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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t _L Advanced <br /> CHAIN OF CURDY RECORD <br /> - GCOEnvit <br /> `"011111et�idl, IncC �Q Cj3 � G� Date S ��. Page of _ <br /> _ GCS <br /> 4005 North Wilson Way Slocklon California 95205 (209)467 1006 F (209)467 1118 <br /> Client � A CI � `� ' Project Mana er /, - Tests Required <br /> Phone Number <br /> Samplers (Signature) ct.Q Invoice <br /> AGE <br /> Project Name l r ( 1 t v Clieni ❑ <br /> Sample Location Sample Type No of <br /> Number Description Dale Time Water Solid LS?{ Ra / Notes <br /> Comp Grab Air Cents /` /C \ i <br /> rA1l W 12)- MSc.CSL n E� �.D z S-a <br /> k Mv}li I ('vel -.E11 �n1u <br /> mw �'�" � scrfc�t <br /> T. <br /> ±0 o <br /> M IL-1 1l'yQl q '. <br /> r <br /> N1 w C, �xr� � C40410 (.) 1 . 3- 3S <br /> N1 w F 'S a, Sp 5 D <br /> Nra <br /> , i <br /> S 2 �l4cy �iT�( N1u�rCtt�Ul Na L 1 ' S5 <br /> RelinquishedC�" ( rgnaluro} aceive y rgnalure Date/Time <br /> z—, <br /> S-T191�f� ��� 5W/(�- ofl 3r7 <br /> flehnqurshed by (Signature) lie ��r,�f 16"? lu Dale/Tim <br /> V I1.,.��1If 1`41 it t' <br /> Hehnquished by R�r�l+u(r�e} ,r —� I ri f s li l }t r ue by obit. 4 hosiery for held analysis (Srgnalure) Date/Time <br /> fi r-l'Lel 1 tr ry71f� I A.11 1 , 4 <br /> I ;� r r rri _ r� 4� <br /> Dispalched by (5igrt`alt ��r{�l Y,GJiI� VflI�SlfJi_IS Dale/limor c ved (air Laboratory by S Date/Time <br /> I 1 lJ <br /> Method of Shipment , L orelory Na e <br /> Spawal lnsttucbons I hereby authorize the performance of The above indicated work <br /> c SC >u <br />
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