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ARCHIVED REPORTS XR0000699
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 XR0000699
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Entry Properties
Last modified
2/15/2019 7:42:13 PM
Creation date
2/15/2019 4:18:20 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000699
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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`sss <br /> � � 011111111111111 111111111110 1W MONSOON MONSOON! SIEMENS MONSOON <br /> CAS E ANALYTICAL LABORATORY 14169- CHAIN OF ,CUSTODY <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE—/—OF <br /> Phone (209) 384-2930 - Fax (209) 3844-1507 <br /> Customer1 (' CI1iI► rfl G REQUESTED ANALYSES Method of Shipment <br /> sAddress ,- a k.) <br /> G <br /> City/State/ZIP L N Notes dxila)_ <br /> Ir <br /> Phone 1 FAX- g 4 W �d <br /> Prod /1 I P O J1 ,1 e a Q a veXled <br /> Report Attention W a = a o <br /> a � m W <br /> Sampler Signature m <br /> Printed- <br /> z <br /> Lab IN SAMPLE ID DATE TIME DESCRIPTIONMOCATION R c <br /> U <br /> 1, 04257 <br /> r <br /> c}, ;�lz*,T� T 1 _ 04258 r <br /> - s a 04269 <br /> 3 . M z -qs a 34260 <br /> 04261 ' <br /> _ T r 04262 <br /> - - - - N 04263 <br /> Total number of containers submitted to <br /> = tionature Printed Name Date Time Company Name the laboratory <br /> Relinquished by L a Note All special requests(e g quids <br /> Received by , �-GLA 3 tum itmes)must be cleared through <br /> authorized laboratory personnel <br /> Rellnqurshe <br /> Received by <br /> RESULTS DUE <br /> Relinquished by IATE <br /> Reserved by VERBAL tM21TTEf <br />
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