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ARCHIVED REPORTS XR0000661
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 XR0000661
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Entry Properties
Last modified
2/15/2019 6:54:56 PM
Creation date
2/15/2019 3:13:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000661
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
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EHD - Public
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t <br /> Advanced CHAIN OF CUSTODY CORD <br /> GeoEnvironmental, Inc. Date Page 1 of–3— <br /> -., <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467 1118 <br /> ClientProject Manage <br /> Tests Required <br /> . i , <br /> Zone),qU7 <br /> Number <br /> r <br /> rs (Signature) Invoice <br /> Project NameAGE7- <br /> ff �t Client ❑ <br /> s J t ,� <br /> Sample Location Date Time WaSample Typeter Solid No f Notes <br /> o <br /> Number Description Air Conts <br /> Comp Grab <br /> 55956a�;QJK 07- - <br /> T_-55959X XNx/ <br /> _ <br /> 00 1427�YO <br /> •- 1 �� l� 55961 _ - <br /> NX1 __ 5596a r _ <br /> 55964 <br /> Rel i qu s e y Signa ure) ece y (Signature) <br /> 1 <br /> Reil quashed by (signature) Received b j f �� � � 4 "` DatefTime <br /> 1Ct�t-1F1� <br /> Rei riquished by (Signature) ,i r1 0 iiiWed b Vbhlfe h oratoryifor field analysis (Signature) Date/Time <br /> KAT SPACE ABSB iCG dT�E�J�it` <br /> Dispatched by (Signature) Dale/Time ved for Labor tory by _ c Date/Time <br /> Method of Shipm l Laboratgty Ake <br /> Special Instructions I hereby a raze the performance of the above indicated work <br /> pJ t - <br />
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