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ARCHIVED REPORTS XR0000764
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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B
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BEVERLY
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104
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2900 - Site Mitigation Program
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PR0540667
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ARCHIVED REPORTS XR0000764
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Entry Properties
Last modified
2/8/2019 10:20:04 AM
Creation date
2/8/2019 9:36:10 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000764
RECORD_ID
PR0540667
PE
2960
FACILITY_ID
FA0023252
FACILITY_NAME
WELDON CHURCH PROPERTY
STREET_NUMBER
104
Direction
W
STREET_NAME
BEVERLY
STREET_TYPE
PL
City
TRACY
Zip
95376
CURRENT_STATUS
01
SITE_LOCATION
104 W BEVERLY PL
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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aaw� � �� tttttttt� tttttllll� � t� aftttttt■t t�� � t� � tllllllll� tlllllllll� <br /> i <br /> ( Advanced CHAIN OF CWUSTODY RECORD7� . <br /> GeoEnvironmental, Inc. <br /> Date Page of 2- <br /> 837 Shaw Road - Stockton, California-95215-(209)467-1006- Fax (209) 467-1118 <br /> Clientr Proj Manag (( Tests Required <br /> 1 %�)U, I- <br /> P 'one Number <br /> 5amp s: (Si ature) invoice: <br /> Project Name AGE <br /> k)to- //amA A Client ❑ <br /> Sample Location Sample Type ' <br /> Date TimeWater Solid No. of + Notes <br /> Number Description Comp. Grab. Air Cont5. <br /> KimZ <br /> d�� 3.-� 3 2- A- � <br /> Me--2-3 e 3(-7 X <br /> d�.—.2-3 V <br /> mto 2-1 1 <br /> e inqui. y ignatureReceived y: (Signature) le <br /> R'le/Ti <br /> Relinquished by: (Signature) Received by: (Signature) Datellime, <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Signature) Datorrime <br /> L3! on <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Date/Time <br /> i <br /> Method of Shipment: Labor " <br /> tir U ' t---�� <br /> 61ST— <br /> Special Instructions: fr I hereby au rize t e erformance of the above indicated work.' <br />
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