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ARCHIVED REPORTS XR0000698
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 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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CASTLARNALYTICALLABORATORY aiN OF cusTouO <br /> w ?� <br /> Location 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 Certificate No 2079 <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 � � _ '_ <br /> PAGE-OF, <br /> Phone (2091384-2930 - Fax (209) 384-1507 _ _ _ <br /> _a <br /> Customer t , _ r� �L HEdt1 -ESTE ANALYSES Method of Shipment Y <br /> , <br /> Address21 <br /> ► _ s <br /> City/State/ZIP �j r �'c • s' ' °° b x o z r <br /> H a Q Notes <br /> Phone 1 FAX _ - r , _ a w in Z <br /> 4 , <br /> ^ r <br /> Report Attention �� t , u, g a `< o - - <br /> Uj E F F a� C a <br /> Sampler Signature - a g „ m i m - <br /> Printed <br /> z <br /> Lab IDN SAMPLE ID -DATE TIME .i DESCRIPTIONI OCATION �� r1RSFA1lATinftcroG�+rn�� ' <br /> L ��= ��j 1�; off, '12723 <br /> 4 <br /> ' 12724 <br /> 0 _ 12725 <br /> s <br /> I <br /> (� - r �L 76 <br /> 7 <br /> r 3, --12727�g ry <br /> ' 12/ 27 <br /> - _ 12725 {{ <br /> y <br /> V <br /> - '12729 <br /> G <br /> RE ERVAPON 12 7 2 g <br /> 4 /� ! <br /> 10FRIATF , <br /> IHLn WN AINM 12330 ' <br /> Total number of containers submitted to <br /> Signa re Printed Name Date Time Company Name u,e laboratory <br /> Relinquished 13116�C '6 ( ' ,, �r� �, Note All special requests(e g quick �? <br /> -, - _ turn times)must be cleared through r <br /> Received by �l L�� ct�,_ /�j�z. ' '' (ci 1� r � /.i I" , 'e authvnzed laboratory personnel <br /> - Relinquished by - - <br /> Received by <br /> Relinquished byJ - <br /> ` RESULTS DUE <br /> - <br /> VERBAL I a WRITTEN <br /> Received by - ' <br /> •W- S ' <br />
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