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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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0,57- 1013 <br /> ( Advanced CHAIN OF CUSTOD RECORD <br /> _==- GeoEnvironmental, Inc. Date Y. 4 Page --L 04-11 <br /> 837 Shaw Road-Stockton, California-95295 - (209)467-1006 - Fax (209)467-1118 <br /> Client ' Ll FA L Project Manager <br /> Tests Required <br /> Phone Number <br /> -Z %! <br /> Samplers (Signature) Invoice <br /> Project Name <br /> ti's ' Client p _ <br /> Sample Location Sample Type <br /> Number Description <br /> Date Time Water Air Solid No of <br /> Conts �� Notes <br /> Comp Grab <br /> `Aj JA !� 5 f�+-Iofr A F� <br /> vth Yd Felt 3r- l <br /> l <br /> �I <br /> Relinquished yigna ure Receivedy (Signature) Date/Trmei <br /> Reti quashed by (Signature Received by (Signature) ��� �! DateR er ,�f 1 <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signatures Date/Time <br /> Dispatched by (Signature) Date(Time Received for Laboratory by D tafTime <br /> Method of Shipment Laboratory Name <br /> Special(nsttucttont I hereby authorize the performance of the above indicated work <br /> 6�—Ci't <br /> I <br />
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