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ARCHIVED REPORTS XR0000663
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 XR0000663
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Entry Properties
Last modified
2/15/2019 10:21:30 PM
Creation date
2/15/2019 3:15:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000663
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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CHAIN OF CUSTODRECORD <br /> � Advanced '& <br /> -_ GeoEnvironmental, Inc Date Di'I-V_cs� Page JJ( of <br /> 04 p 2�p� <br /> 837 Shaw Road- Stockton, California- 95215- (209)467-1006-Fax(209) 467 1118 <br /> Client iLK rD o Ft9m r)v I- r Project Manager 1 I CvU Tests Required <br /> Phone Number htr <br /> ( L <br /> Samplers (Signature) ' ti'" , 4� Invoice <br /> Project Name AGE <br /> RAG Q' / Q J . Vp G i"J ,� Q ' w ,�w� Client ❑ <br /> r <br /> Sample Location pate Time WatepriBTy� Solid No of �� � <br /> Number Description Air Conte �� �� �` Notes <br /> Comp Graf <br /> 'c� Ta Sat l arise Nnyl ger wrFtr 3+t'•43 <br /> Z�SRM � �utlfi s�Twr✓15t;La C1�7yo-a`I /4:©u i-L u <br /> ' -114 L/ r r+ 37 s Y F 10 a rr <br /> to t rt �r Y rj IS , 7� <br /> rs;t, t3,rrr 9y r <br /> GrAa wRttr <br /> 116riA 13fW-V d r F o -lo-uv 'x ' o 0 ry X x x X <br /> I' h <br /> rt ri rr <br /> 'r <br /> �. <br /> It r 90`I►Y " tit to-0 4,15 �( +r X <br /> f a S��I ��rr� �yeA ;Gr;gb w Tei` r <br /> ktA ��� j S � V 1�lS�yF� or�x1-fl`� Ifl;l� ►r X X � <br /> rt I► rr r rr I <br /> foA-ql 51 rt r � ] $t FT ny L) a Iay S rrXX <br /> TV <br /> Sri <br /> So.) bran P 3rir Gr,AR, rr <br /> �� C �Q C rtt9 n15e1s) FT, (k'xr•q r7�; �5 !r <br /> e in s e y +gn ure ece ve y ignalure <br /> _ Data time <br /> G S 7 f --L z a 04-1 <br /> Relinquished by (Signature) Received by (Signature) Date/Tim <br /> Relinquished by (Signature) Received by Mobile Laboratory far field analysis (Signature) Date/time <br /> Dispatched by (Signature) Date/time Rao or Laborato / Da <br /> Method of Shipment a Lab tory Name <br /> cA nvaNicaTCLOf "L <br /> Special Instructions p 1CPJfJ ,`r I hereby authorize 1h6 performance of the above indicated work I <br /> R 1 f 00D C0NDTTI0N 6:::: A"ROPRTATS r <br /> $EAn <br /> I]EOILORMAII3D IN LAB-PRESSRVM INI J <br /> pRESERVAMON <br />
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