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ARCHIVED REPORTS XR0000700
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 XR0000700
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Entry Properties
Last modified
2/15/2019 6:47:05 PM
Creation date
2/15/2019 4:18:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000700
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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� � 2( Tc C tttttttttt� �� tttttttttt� <br /> CASTLE ANALYTICAL LABORATORY y a AIN OF CUSTODY <br /> Location 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 Certificate No 2079 <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE-1—DFL <br /> Phone (209} 384-2930 - Fax 12091 384-1507 <br /> Customer @nl'I REQUES ANALYSES Method of Shipment <br /> Address ^I-I1 t.0'IS c►� - <br /> City/State/ZIP V " � o y z Notes <br /> W <br /> Phone 1 FAX �i q -7-r r W W <br /> CO z <br /> Pro( # I P 0 # O n o- W V a "' w a v <br /> 1>z � � � <br /> Report Attention 2— W R ° a o <br /> Sampler Signature ~ a <br /> .a <br /> m S lit <br /> Printed o <br /> z <br /> Lab ID* SAMPLE ID DATE TIME DESCRIPTIONILOCATION Y OaSERVATIONSIREMARKS <br /> (10 <br /> (10 <br /> Il-ry II ' I _ l 9850pity G�� <br /> -5111-10 q ` 3 <br /> M }I-to �� ,r0 E -- <br /> Mw i1-o�Ik Z IS I 98508. <br /> . .9 8 5.1 w <br /> .._ <br /> 98511 <br /> I <br /> Total number of containers submitted to <br /> 114 /141gqature Printed Name date Time Company Name the laboratory <br /> Relinquished 6y Note All special requests(e g quick <br /> Received by LCt w ��� r�- g tum limes)must be cleared through <br /> authorized laboratory personnel <br /> Relinquished by <br /> Received by <br /> Relinquished by IEEJi� fill RESULTS DUE <br /> Received by GOOD CONDITION ISI' VERBAL WRIrrE <br /> CONTAINERS <br />
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