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ARCHIVED REPORTS XR0000667
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 XR0000667
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Entry Properties
Last modified
2/15/2019 10:16:01 PM
Creation date
2/15/2019 3:18:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000667
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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� �� sts>� r, t� ■� t� � � � i S fs � � i♦ 1♦ f♦ <br /> Advanced CHAIN/OF, CUSTODY RECORD <br /> GeciEnvironmental, Inc. 0318(15 Date Z- Page of- - � <br /> 637 Shaw Road- Stockton, California- 95215- (209)467 1008-Fax(209)467-1118 <br /> Client � '1 111101, fPro act Man r <br /> " Tests Required <br /> Ffiono i4yrnbpr <br /> " <br /> {Sig re) Invoice <br /> Project Name , AGE 12- <br /> Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> VQA <br /> GOOD CONDMION—Je PRP 'E'E <br /> VP,D SPACE SENT toNT <br /> D: I <br /> e r a e y i al <br /> Received y (Sig—n—W—rar te/Ti71w Relinquished by (Signature) Received by (Signature) Z <br /> WWI <br /> ellnqu s e y (SlQnatura} Received by Mobile Laboratory for lield analysis (Signature} Dale/Time <br /> Dispatched by (Signature) DatelTimeeceived r Laborato D elrime <br /> Method of Shipment r Laboratory Na <br /> mp <br /> Special Instructions UI hereby a )ze 1he p or ince of thJ above Indicated work <br />
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