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ARCHIVED REPORTS XR0000686
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 XR0000686
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Entry Properties
Last modified
2/15/2019 7:29:01 PM
Creation date
2/15/2019 4:04:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000686
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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t, Advanced CHAIN OF CUSTODOECORD <br /> GeoEnvironmental, Inc. Date z�r-' Page ._..67—of-_ <br /> 837 S aw Road-Stockton, California-95215 - (209) 467-1008- Fax (249)487-1119 <br /> Client Project Manager <br /> Tests Required <br /> Phone Number <br /> Sample (Signature) / Invoice, <br /> Project Name AGE ' <br /> •4 �� ii Client p <br /> Sample Location SampleType No of J� <br /> Number Description Date Time Water Aar Solid Conts ( ` Notes <br /> Comp Grab Y <br /> /2 Z-S" <br /> CZ"] zo 2741 <br /> e Rmqus )ate/T�me <br /> s <br /> JV <br /> Rolq s e 61 by igna ra) Received by (Signature) Daterrirne <br /> 1 <br /> Relinq6`iiha by W10hufura) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Iflecelved for boral Date(ilme <br /> Method of Shipment Laboratory Name <br /> �u <br /> Special Instructions I hereby authrige the performance of the above indicated work <br />
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