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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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( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmentai, Inc. Date Page --L of� <br /> 937 Shaw Road- Stockton, California- 95215 - (209)467-1006-Fax (209)467-1118 os- 0 3 <br /> Client BoKioo FAm ), L Project Manager — Tests Required <br /> C u dlAA <br /> Phone Number <br /> zf,q) V07 -/ oe; lp <br /> Samplers (Signature) �•►`� Invoice; <br /> Project Name FIA 6- C;T-/ C AGE <br /> ��vr�n IV, Client ❑ <br /> a`� <br /> Sample Location Sample Type A, <br /> Date Time Water Solid CUrrts Notes <br /> Number Description Comp crab <br /> Air qq �� t:+ Am Arr1fD,'A <br /> v1.Kel 4 1 8-11'03 7'y5 Xf, <br /> 0,41,4. A T A t 57- <br /> 4 V <br /> e nquis e y i ature Received y ignature <br /> 57,097 Date/Time <br /> Relinquished by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelTime Received for Lebor by DatelTime <br /> Method of Shipment Laboratory Name <br /> C O u CAL TicH <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br /> 7v;o WL <br />
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