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ARCHIVED REPORTS XR0000649
Environmental Health - Public
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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 XR0000649
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Entry Properties
Last modified
2/15/2019 8:14:48 PM
Creation date
2/15/2019 3:09:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000649
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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_ TOARECORD <br /> � Advanced CHAIN OF CUSi <br /> Date <br /> _-w GeoEnviron mental, Inc 0�* <br /> 837 Shaw Road- Stockton California - 95215 (209)467 1006- Fax (209) 467-1118 <br /> i <br /> Project Manaa er <br /> Client 1°C_�� �� �, C ' � ''a� L �,t'� � Tests Required <br /> hone Number <br /> Samplers (Signature) � Invoice <br /> AGE <br /> Client <br /> Project Name <br /> ❑ <br /> Sample Type <br /> /v r <br /> Sample Location NO of Notes <br /> / <br /> Date Time Water Solid // <br /> Number Description comp Grab Air Conts <br /> q ACX ' <br /> > >k �tW _ C <br /> Y X Y <br /> Al <br /> r.r'l✓" <br /> alrTim <br /> Tim <br /> e <br /> LL- <br /> e in ia Si at re (Signature) <br /> Relinquish d by (Signature) Received by (Signature) <br /> Date <br /> 1CFW <br /> PF 1ATFt <br /> GOOD CONN r`ON <br /> r Relinquished by (Si�6�ti?r8)'ACE H .S y Mobile Laboratory for field analysis (Signature) faetelTime <br /> pgCF3I.ORlNATED IN LA13 PRE5ER.VQ <br /> p METALSO'IHM <br /> Dispatched by (S'grf�t RVAnrUN DatelTime Re r oratory by U lot 1Me <br /> 36 6S g/S- <br /> Method of Shipment Laboratory Name <br /> Special instructions <br /> J( ! hereby authorize the perlorman a of the above indwated work <br /> J <br /> REC'D SEALED & INTACT VIA <br /> 7 <br />
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