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ARCHIVED REPORTS XR0000698
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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 XR0000698
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Entry Properties
Last modified
2/15/2019 9:07:44 PM
Creation date
2/15/2019 4:17:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000698
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
Scanner
WNg
Tags
EHD - Public
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J _ <br /> CASTLWNALYT �ICAL LABORATORY 7 << t'��, AIN of CusT*' r" <br /> Location 2333,Shuttle Drive, Bldg 908/909, Atwater, CA 95301 Certificate No 2079 _ <br /> , <br /> Mailing Address 2333 Shuttle Drive Atwater CA 95301 - PAGE _ OF ` <br /> Phone 12091 384 2930 Fax (209) 384 1507 <br /> Customer �� t , 1 i REQUESTELI ANALYSES Method of Shipment <br /> Address G I <br /> City/Statelzip �� - - ` r c - c �' b x o z Notes - <br /> Phone ! FAX c - — f iC, -( - w U b `� �, z - <br /> PrOJr# IP0 # C7— (' t ^t 0. e w 'n a `° o v 1 O <br /> Report Attention - _ , t r w a " s `< o <br /> � Eo ►- u; w t a <br /> Sampler 5lgnature g I m - <br /> Printed <br /> Lab IDA' SAMPLE ID _ DATE `TIME DESCRIPTIONMOCATION TInh,C rorr�nnvr <br /> } L� � ` o -12723 ; <br /> ' <br /> 12724 <br /> t TAAL — _ <br /> 12725' <br /> i <br /> , <br /> 1272V , <br /> 12720 '- <br /> if <br /> 2728 - <br /> , <br /> PRE11 RAM <br /> 12729 <br /> Ufflu UI'qiA _ - <br /> 12730 <br /> Total number of oonlainers submitted to <br /> - Signa re Printed Name Date Time Company Name theteborator/ <br /> C ` ;1i v Note All special requests leg quick <br /> ' Relinquished h _ 'r �`� _ turn times}must be cleared through <br /> Received by �1/f•tti r J r c� �Tr j ' '' �� � rr rJrj '" ` ��' authorized laboratorypersonnel <br /> Relinquished by - <br /> Reca'wed by - <br /> Relinquished by ` ,i r RESULTS DUE <br /> Received by VERBAL, { WRITTEN <br /> ='r � � r � �r rrT' � � � � o � � � r . I� , � ■� r. it _ <br />
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