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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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Advanced CHAIN OF CUSTODY ECORD <br /> ���GeoEnvironmental Inc. Date n 9- Page of <br /> -' of Nonhenz California <br /> 1B03 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956-0700 <br /> ClientProject Manager <br /> ,� � G ' C� n :�) — C el C Tests Required <br /> = Phone Number <br /> i aoq SLl <br /> - Samplers: (Signature) Invoice: <br /> Project Name AGE [� <br /> "/ Client p <br /> Ci C n f <br /> Sample Type <br /> Sample Location Solid No. of Notes <br /> Date Time Water <br /> Number Description Air Conts. <br />! Comp. Grab. r <br /> #i4 80=5.8-6�.. <br /> � k <br /> P , q <br /> Py r 68 <br /> , . . <br /> Dale/Time <br /> i `quks a y: (Signature) ecekve y: (Signature) C�..�—�N��� t r <br /> l S, J -.o�-�1� 5 r0o <br /> Relinquid Vy: Signature) Received by: (Signature) Date/Time <br /> CA qvft 1w-r I 9MdPLLU:G D 3p <br /> Relinquished by: (Signature) RecWivecl by Mobile Laboratory for field analysis: (Signature) ate/Time <br /> Dispatched by: (Signature) Date/Time Received for laboratory by: Date/Time <br /> i <br /> Method of Shipment: A) C' &. WAIL Laborat ry Name <br /> r <br /> Specfal Instructions: I hereby authormance'ol the above Indicated work. <br /> anni)- V, MES�MATION <br /> HEAD SPACE A$SE v' �{fr f,irjj��;[ �// <br /> VIJIYI rIiLr•S � - <br />
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