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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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+_ �� �� fl�l � i� l� fiiiiii�l f� � � � � I• � � � <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> -- GeoEnvironmental, Inc. Datet~ Page ---L_ of <br /> 837 Shaw Road-Stockton, Callfornia- 95215- (249)467-1006- Fax(209) 467-1118 <br /> Client i Project Manpr <br /> 7 U �/& il_ Tests Required <br /> Pine Number <br /> h <br /> P s (Si nature) Invoice <br /> Project Name f AGE„©' <br /> /- l's�' Client <br /> Sample Location Sample Type <br /> Date Time Solid No of <br /> Number Description _ Water Air Cants \ Notes <br /> Comp Grab <br /> --4 rte' ` -ol"40 <br /> v car r r a^rsr. <br /> If t C'° j[TIt]M APPRON,:E <br /> 1 I ,-x CONT-%7N— 3 w V <br /> �e nq sheA ygn urs ece v y i n t <br /> � f �� D telTrme <br /> Relinquished by (Signature)1 Received by (Signature) <br /> DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date rime � <br /> 3 <br /> Dispatched by (Signature) Dateffime Receive or Laboratory by Dateffime <br /> Method of Shipment / Laborator NaM94 0 1 "1 <br /> Uy(0 J � <br /> t_ <br /> Special Instructions I hereb <br /> y uthor a the p rmancelof the above indicated work <br /> � r <br /> Fin _ <br />
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