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ARCHIVED REPORTS XR0000701
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 XR0000701
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Entry Properties
Last modified
2/15/2019 7:04:52 PM
Creation date
2/15/2019 4:21:53 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000701
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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CASTLE ANALYTICAL LABORATORY 1167 6 Q)04G1 CHAIN OF CUSTODY <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater CA 95301 Certificate Na U79 <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE OF <br /> Phone (209) 384 2930 - Fax (209) 384 1507 <br /> Customer O INP—A 17 (--r_ REOUEqTEOIANALYSES Method of Shipment <br /> Address co S U3 <br /> CItylState/ZIP L C .e� <7s S Q' '—` 4 C z <br /> ,;, y o: � i Notes <br /> Phone / FAX ° < <br /> 209 6 7-(Cr6 4 7- f( (k s z <br /> W o 2 v W � m 0 <br /> Prol # I P O # — a �, a o v v <br /> Report Attention Ui Q 2 v a s o <br /> d <br /> Sampler Signature U' yCo <br /> m ~ ~ <br /> Printed � N �y z <br /> rl <br /> Lab ID# SAMPLE 10 DATE TIME 0ESCR1PTIONILOCATION ' OBSERVATIONSIREMARKS <br /> w6_35' c 211 >11 <br /> MUJ 7 _ 30 " 1 { <br /> Total number of containers sub ed to <br /> Signature Prlrlted Name Date Time Company Name the laboratory <br /> Relinquished by 1 7 rJ Note Ali special requests( g k <br /> Received by ��4G C t n times)must be cleared hr u h <br /> 4tp thorned laboratory perso I <br /> Relinquished by <br /> Received by WAS I ON I METALS Tk <br /> Relinquished by <br /> RESULTS DUE <br /> Received by VERBAL WRITTEN <br />
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