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ARCHIVED REPORTS XR0000703
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 XR0000703
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Entry Properties
Last modified
2/15/2019 10:02:47 PM
Creation date
2/15/2019 4:23:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000703
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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�� tttttttttaw tiffttttf� 111111111 � I! � � li � � �� � <br /> Advanced CHAIN OF CUSTODY RECORD` <br /> - GeoEnvironmental, Inc. Date Page of <br /> of Norihern California <br /> 1803 West March Lane, Suite A•Stockton,California-95207-(209)956-0264-Fax(209)95M700 <br /> Client C-14qvroso <br /> Project Manager C Tests Required <br /> cf <br /> Phone Number <br /> Samplers: (Signature) Invoice: " <br /> I: <br /> Project Name AGE <br /> Client ❑ <br /> Sample Location Sample Type ; <br /> Date Time Water Solid No. of , <br /> Number Description <br /> ks. <br /> Comp. Grab. Air Con - --- , <br /> 4�s r N 505. 10 <br /> —80511 <br /> 005-12 ` <br /> Y� <br /> � r80'5 13 , <br /> V/✓ QL t <br /> 80.5-15 <br /> eITqurs e y: (Signature) eceve y: (Sig Hire) <br /> DalelTime <br /> Re~,IuiUr <br /> rr G 6:0p <br /> Re;, Oby <br /> (Si lure) I U) A� ate ime <br /> ?�� �- o0 <br /> ReReMobileLaboratory for field analysis: (Signature) D elTime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: pa[elTime <br /> Method of Shipment: n n �ftboratory Name <br /> Special Instructions: I hereby authorize the performance of the ove Indicated work.AS ON YGInLSOTllR <br /> YAr <br /> GOOD CONDITION APPROPRIATE �iy� <br />
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