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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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�a A� AMA !lam t� 11MI 1=11 11M1 <br /> ( Advanced CHAIN OF CUSTODY ICORD <br /> GeoEnvlronmental, Inc. DatePage of <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467-1006-Fax(209)467-1118 <br /> ClientProject Manager <br /> 11911�- Tests Required <br /> eAa� <br /> P a Number <br /> W67 ZW6 <br /> (Sig azure) Invoice <br /> Project Name AGE./ <br /> j �'{� Client ❑ <br /> Type le Typ � <br /> Sample Location No of Notes <br /> Number Description Date Time Sample <br /> Water Air Solid Conts _ <br /> Camp Grab <br /> F10-10 X1 Ix Ix X -- 559fi5W� - <br /> IL2 7X/L-/ <br /> �� 66 <br /> .Fu) A.Ze ,r� k- __55967 <br /> r3,c,� <br /> 1 15 � <br /> coj 1060 ?C' - -55969 <br /> 55970 <br /> 5697 <br /> a i is a y ignatufa ece ve y ignalure <br /> R linquished by (Signatur rreceived by (Sign 1,FT�� ate[Time <br /> p 1" <br /> Relinquished by (Signature) ] 1 + J, obit laroVi or I analysis (Signature) DatelTime <br /> HLAD SPAC ADSL T lco, liiVEnS.____ <br /> Dispatched by (Signature) Date/Time c ved for Labor 19toy Date/Time <br /> �,ioeq <br /> Method of Shipment V Laboratory <br /> '51' nq <br /> Rc-�L,,L� <br /> Special instructions 1 hereby author perfor nee of the bove indicated work <br />
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