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ARCHIVED REPORTS XR0000665
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 XR0000665
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Entry Properties
Last modified
2/15/2019 9:44:01 PM
Creation date
2/15/2019 3:16:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000665
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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I <br /> Advanced <br /> CHAIN F USTO CORD <br /> � <br /> -- GeoEnvironmental, Inc. Date `7 Paye of +� <br /> 837 Shaw Road- Stockton, California- 95215 - (209)467 1006 - Fax (209)467-1118 <br /> Client Pro nag / Tests Required f <br /> P in Nuber <br /> t <br /> IT 46 Z <br /> /47-6 <br /> am (S ature) Invoice <br /> AGEI <br /> Project Name' r e � Client, ❑ <br /> rw <br /> Sample Location Sample Type No of <br /> Date Time Water Solid Notes R <br /> Number Description Comp Grab IAir Conts <br /> IC81 <br /> U <br /> IIF D SPACE ARS a <br /> CONT <br /> 1NF?RS <br /> DG 1LORINATED PRES RVE <br /> PR SERVATIdt,TI ITT <br /> e invs y tg atu ece va y ignalure YUD s Mme f <br /> I 'LJ/ <br /> Relinquished by (Signature) Received by (Signature) ale/I Ime <br /> Relinquished by (Stgnature) f;ecenred by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Re f, boratoryby Da /re e// <br /> Q il�� <br /> Method of Shipment Laboratory t{ (-v, )bd <br /> �Il <br /> jJt <br /> S ectal Instructions I hereby aut za the pe o once of the above indicated work <br /> p RECD SEALED&IN ACT VIA "I <br /> r <br /> i � <br />
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