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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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i • <br /> f <br /> Advanced CHA!N F/CUSTODY ECORD <br /> GeoEnvironmental, Inc. --1g9 Date Page - -- °f -�— <br /> 837 Shaw Road -Stockton, California -95215 - (209) 467-1006-Fax (209)467-1118 <br /> Chant Project Manager� � � � , Tests Required <br /> Mee Number <br /> ignature) Invoice <br />� Project Name 7ja'�t— <br /> '�� Client <br /> Sample Locatio Date Time Sample Type Solid No of Notes <br /> Number Description Water Air Conts v <br /> Comp Grab c <br /> I � <br /> 322- 89612 <br /> r <br /> 89613 <br /> V10-1 131 <br /> � pf�r�,f +I <br /> oil <br /> ^ M1sfi l'"tf� _' <br /> ACE <br /> (�C 1iJLJ 1 L 3 r <br /> lj�I1i1 u1V irlc,til <br /> Re inq i ed y Vna re} ace ve y igaature R a/Tlma <br /> 16tto <br /> Relin u[shed by (Signature) VReceived by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) Date(Time <br /> I <br /> Dispatched by (Signature) Date/Time Received for Laboratory by {, /�DatelTime <br /> I C7`I/ <br /> Method of Shipment La oratoryam <br /> Of& 10,0 to— <br /> lnst[ucttoas <br /> sut r e the pe <br /> Spec[ai 1 hereby rt mance of he above indicated work <br /> f4Ltl NJ seal i <br /> w <br />
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