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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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t ;- z" <br /> `.4P, , <br /> CHAIN OF CUST, ) R5COR <br /> j Advanced Y' <br /> _-= GeoEnvironmental, Inc. Date Page _ of� <br /> 4005 North Wilson Way-Stockton,Calitornia-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Pro a ager Tests Re <br /> Jwequlred �1 <br /> nrk� <br /> r ..1.Sn.1^LY1ri.iV�'re <br /> Ph ne Numb <br /> 4LZ O ♦ �( S� k�' �rr\ <br /> 1,Sam-pie�r (St mature) lrn .olce' <br /> r <br /> �cti r4�r x .�r�xiin' <br /> 1 GEr <br /> Project Name Y`t Client <br /> i <br /> Sample Type "1 <br /> Sample Location date Time Solid No of - Notes ,% <br /> Number Description compVateGrab Air Conts <br /> a <br /> 41 I J, <br /> qI <br /> �. 1 k tM <br /> r <br /> t+fir dN <br /> c t <br /> etinquic ( rgneceive y ignature Reby (signature) Received by (Signature) Date time <br /> v, *. <br /> Datefflm! <br /> Re6nqurshed by (Signature) Received by Mobile Laboratory for fidld analysis (Signature) ;y <br /> Date/Time Received for Laboratory by • r �,' DaleRlme{r }��' <br /> Dispatched by (Signature) , "i'� ra <br /> vN 4 <br /> la <br /> Method of Shipment LaboralorI <br /> me <br /> J111 ]a <br /> Spacial Instructions i hereby a o ze the rlorman e,o(,the'ebova;indlCaled.wofk <br /> U. ) i i i1'f <br /> h <br /> Y )) <br /> I� <br /> V <br />
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