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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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C" cj D E RD <br /> [ Advanced <br /> CHAIN OF CUSTO � CO <br /> GeoEnvironmental, Inc Date ':5k' ' page —L- of-7 <br /> 937 Shaw Road- Stockton, California-95215 - (209)467-1006- Fax (209) 467-1118 <br /> Clientproject Manager <br /> Tests Required <br /> -L rt- <br /> Phone Number 7 <br /> Samplers (Signature) i� Invoice <br /> / AGE <br /> Project Name f /�1-7- � Client E] <br /> Sample Type <br /> Sample Location Date Time Water Solid No of �� Notes <br /> Number Description Camp t3rab Air Conts <br /> 4&3 V [ <br /> 173 P �'C Y — <br /> tF <br /> -,m4,4J 4'16 t�_ "S" ry_ <br /> e inquis by (Sign re Received y (Signature) Date/Time <br /> Sell`(q y sl ature Received by (Signature) f;� "—'� Dale/Time <br /> 1a - k. .),) , <br /> Reiinq shed by Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) V i'i" . l;�„ Qg(T� a Aece d la Pa ry Date/Time <br /> 1" 17110 F <br /> Method of 8 Irnl� �,(+ + 1'A1hx'a °3(AfE Laboratory Name <br /> � r R 1 liq°jn % ' 1 �1�� <br /> Special l t „ �� `"" / I hereby ul orize thl performance of the above Indicated work <br />
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