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ARCHIVED REPORTS XR0000696
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 XR0000696
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Entry Properties
Last modified
2/15/2019 9:00:03 PM
Creation date
2/15/2019 4:14:30 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000696
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
Scanner
WNg
Tags
EHD - Public
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i r• tip <br /> CHAIN OF USTUDYJRECO R <br /> Advancedob <br /> - <br /> GeoEnvironmental, Inc Date Page,�, ...eot t <br /> , s „ <br /> t <br /> 4005 North Wilson Way Stockton,Calrfomia-95205 (209)467-1006-Fax(209)467-1118 <br /> Client Pro a ana �F` `''Rf•Rtix >5 <br /> Tests,Required <br /> r <br /> P ne N tuber <br /> sok <br /> 7 /0 6 <br /> ampler` (Sig ure) _IrnrolCe. <br /> Project Name 15ya ,r rr ,q$ �AG� i<4 <br /> °f, ,C6ent <br /> f , <br /> Sample Location Sample Type No, of ��°Ytoitkli;i� <br /> Date Time Water Solid ,�h`i Notes-w='' tri <br /> Number Descriptiontomo Grab Air Conte <br /> Mai /JJz tv <br /> I° F <br /> TIKI swg"y N)V�. <br /> J/ ']l, �7 6 6' <br /> x,rRUMS <br /> .fz�` of <br /> ll a,lati�,v y't ar <br /> f[ r rL�t <br /> e ru e ( fraturey Receivedy rgnature I I r ' 4413alefim�aj}� s, <br /> ani'� ;7frK{`l"v<T <br /> Rehnq is eTW(Signature) Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) � +l," � r �,,DalslTime <br /> L 1 F 1 �v it t• ^-t p...`y <br /> �i'�7f)X51 <br /> Dispatched by (Signature) Date/Time Received for Laboratory by s �Oate(rime;,?33� <br /> 4 = <br /> Method of Shipment Laborato Name ;� } at ,�� ; Y, <br /> V Y, t i f-..1 L <br /> t <br /> Special Instructions Jejpl- <br /> I hereby uthor a the perto mance 4 the above Indicated work- 1 <br /> y 3 4ni <br /> r I, <br />
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