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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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0 0 V <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> -`-% GeoEnvironmental .Inc. Date Page —7— of <br /> 4065 North W{Ison Way Slocklan,CaVriamta 95245-(209)467-1006 Fax(248)467-1118 <br /> Client ProlegManager <br /> Tests Required <br /> P one Number <br /> 14�7 160 6 .� <br /> Sa ers (Signature) Invoice <br /> r� <br /> Project Namew � { AGE <br /> ❑ <br /> Sample t ocatian Sample Type No of <br /> Date Time Water Solid Notes <br /> Number Description Comp Grab Air Coats <br /> 225 <br /> SFS 1 I (v <br /> (Al 0 � -cel_: {' l i7 1 C �`' ty _ <br /> elmq e y iSig�ature) eceive y rgnatura �f11A CC Dale/Tim� e - <br /> ��\ <br /> Relinquished by (Signature cd Signature) 1w � o t. � ; DAefTime <br /> iellnqu{shed by (S{gnatum) DatefTtme <br /> Q1 U Al <br /> { <br /> hspalched by (signature) Date/Timo IM ved,for kaboralory by DatefTlme <br /> 10 <br /> lethod of Shipmentaboralory Na e <br /> h r <br /> pial lnslruchons t hereby avthonze the peYlotm ance oT the above indicated wesk <br /> ���r,_!1 lA nC0.♦ 10� CCl1Y ., � S 1 r�� r-�-� r' <br />
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