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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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( Advanced CHAIN OF CUSTODONECORO <br /> ' - - GeoEnvironmental, Inc. Date Pager, of <br /> 837 Shaw Road Stockton, California 95215 (209) 467 1006 Fax (209) 467-1118 <br /> Client Pro ect Ma ger <br /> A-4- Tests Required <br /> Phone Number <br /> S lers nature) Invoice <br /> Project Name AGE <br /> Client ❑ <br /> SampleLocation Sample Type No of ' <br /> Date Time _ Water Air Solid Conts ` Notes <br /> Number Description Gump Grab <br /> Ir U LU 7— # <br /> � <br /> �1_ t 1 � <br /> I <br /> 1U�S <br /> GOOD ONfITION— PJ OP 'Iz <br /> —UPLAD BA <br /> 4.85 a '�h�}La— y �p <br /> D ECi ILIN1 INIM SIA <br /> -Refinquiy i tui ) ece ve y �gnature �' r� ❑a �Tlma <br /> K <br /> _ 6 <br /> Relinquished by ignalure) Received by (Signature) tatirnme <br /> Relinquished by (Signature) Received by Mobile Laboratoiy for field analysis (Signature) DatatTrme <br /> Dispatched by (Signature) Date/Time a tv d or LaboraI r by 1 Data/Time <br /> Method of Shipment 00 Labdratory Na a <br /> Spec al Instructions I hereby auth tze the <br /> :�\ t�� 1r, � �( 1 v C C'A���� � 1���`�+` -��\ p rmance of the above indicated work <br /> u - - ` <br />
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