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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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rtttt� tttittitit� tititt� �■ i� 1_ tel• tiiiiiiiii� ttiiiiitii� i♦ ttiiiiii� tt� 111111E1111111111 1111111E1111111 <br /> CHAIN OF CUSTODY*CORD <br /> j Advanced <br /> GeciEnvironmental, Inc. Date Page -3- °r-�--- <br /> 4005 North Wilson Way-Stockton,Califomia-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Pro ect Manager <br /> Tests Required <br /> P Pe Number <br /> 9� 6477 <br /> ®L� <br /> Sa rs (Signature) Invoice <br /> Project Name ` AGEk <br /> Client ❑ <br /> i <br /> Sample Location Solid Sample Type No of Nates <br /> a Number Description Date Time Water Air Conts <br /> Comp <br /> RLU <br /> --C' <br /> ., <br /> -&v o �' . _..�_ 559 7 3 _z z <br /> 55976 <br /> ^1 � <br /> MO 55976 <br /> Rat inquignalure ,, Recelvedpy (Signature) �f(1Afi i�' 1 D (Time <br /> Y lJY t � 2 <br /> In. <br /> Kelm wished by (Signature) l�'i� Received by (Si ature) atefTlme <br /> QQ <br /> Relinquished by (Signature) AAIu � obd ab a+yaie (signature) Date(Time <br /> Dispatched by (Signature) DaterTime in ved�*r Laboratoby (2 r�� �') Ww Data Time <br /> ZIla, V <br /> 1 <br /> Method of Shipmer}i) Laboratory Name <br /> Special Instructions I hereby aulho ze he'peri ante of the above indicated work <br />
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