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ARCHIVED REPORTS XR0000677
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 XR0000677
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Entry Properties
Last modified
2/15/2019 8:28:52 PM
Creation date
2/15/2019 3:43:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000677
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 /> l Advanced CHAIN/OF CUSTODY RECORD <br /> `,'Y GeoEnvironmental, Inc. Date7/26 Page at <br /> 837 Shaw Road - Stockton,Callfornia-95215-(209)467-1006- Fax (209)467-1116 <br /> Client - Pro Manage <br /> r Tests Required <br /> Ppme Number <br /> I <br /> Sampl (Signature) Invoice <br /> Project Name AGE Ey' <br /> l' Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Air Solid C o` Notes <br /> Comp Grab I, <br /> 2- � Cr l <br /> e inq is e i nat a Ve y tui <br /> nn D te/Time <br /> Relinqui ed by (Signature) ceiv b (S ature)L <br /> Datelnme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time <br /> Dispatched by (Signature) Dat e/TimaReceived for aboratory by <br /> DatelTime <br /> Method of Shipment J Labors ry Name <br /> af' L-eA-J <br /> 91191) <br /> Special Instructions I hereby authorize the - tf rmance of the above Indicated work <br /> � I• � r• I• � � � � � � � � r � f!• ttttt� <br />
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