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ARCHIVED REPORTS XR0000672
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 XR0000672
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Entry Properties
Last modified
2/15/2019 6:13:55 PM
Creation date
2/15/2019 3:24:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000672
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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L <br /> ( Advanced CHAIN F CUSTODY RECORD <br /> GeoEnvironmental, hic. � .� Date • i7 Page ---L of ! <br /> 837 Shaw Road- Stockton,Caflfornta- 95215- (209)467 1406 Fax (209) 467-1118 <br /> Client X- &La <br /> Pra act Manager Tests Required <br /> 117 <br /> Lonember <br /> d <br /> -- Samplers (Signature) Invoice <br /> Project Name AGE__[ <br /> �. d"'111 l l`vv. �c Client ❑ <br /> Sample Location/ Sample Type` <br /> Date Time No, of <br /> umber Description Water Air Sola! Conts Notes <br /> Cornp Orab <br /> &n Tr . <br /> !t <br /> RalinquKd gnslure FTeceive y gnature 0 e(Time <br /> 7 r <br /> fie711nquiahad by (Signature Received by (Signature) <br /> DelelTima <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DateJTlme Received for Laboratory by _ r De/Time <br /> Method of Shipment _ Laborator Na <br /> special Instructions I herebythorize <br /> parlor no* of the above indicated work <br />
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