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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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CASTLE ANALYTICAL LABORATORYI 9 1pg7AC e 2,3,g-. doc- CHAIN OF CUSTODY <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE—LOF__/ n <br /> Phone (209) 384-2930 - Fax (209) 384-1507 <br /> Customer' m, REQUESTED ANALYSES Method of Shipment <br /> Address A r <br /> City/State/ZIP C S— ! 1 x o 2i <br /> Phone O°b X o -j Nates i <br /> a e / FAX _ <br /> W a W m 318fi9 <br /> Prod # IPO # '( �� WS w i <br /> c <br /> Report Attention a A o <br /> Sampler Signature a $ m ~ W i 1870 <br /> Printed V n i- <br /> Z 31871 I <br /> Lab tb# SAMPLE ID DATE TIME DESCRIPTIONILOCATION OBSERV - - <br /> MWIZ-2 ao2- 31872 <br /> S Z i 2" _ 31873 <br /> I t+1MWq ; r <br /> � � �z�_ Z- x_1874 i <br /> �� 31875 <br /> _ H&0 13K X, 31876 <br /> 31877 <br /> 31878 <br /> J - i <br /> ti y <br /> 31879 <br /> i <br /> , <br /> Total number of containers submitted to <br /> 'Agg4ture Printed ame Qate Time Com any Name the laboratory <br /> Relinquished by �1 - ff Note All special requests(e g quick <br /> Received by �/ � Zea �,g � turn times}must be cleared through <br /> authorized laboratory personnel <br /> Relinquished by <br /> Received by <br /> Relinquished by, RESULTS DUE <br /> Received by 1W ROPRIATE VERBAL WRITTEN <br /> HEAD SPACE ABSENT CONTAINERS <br />
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