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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1610
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2900 - Site Mitigation Program
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PR0524303
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Last modified
2/11/2019 3:29:27 PM
Creation date
2/11/2019 2:51:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0524303
PE
2950
FACILITY_ID
FA0016297
FACILITY_NAME
ARMOUR & BONNIE SMITH 2003 TRUST
STREET_NUMBER
1610
Direction
N
STREET_NAME
BROADWAY
City
STOCKTON
Zip
95205
APN
14325008
CURRENT_STATUS
01
SITE_LOCATION
1610 N BROADWAY
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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gedog cot Teca cs lac. age of <br /> 11017th Street �+ <br /> Modesto,CA chain Of Custody <br /> (209)522-4119 Fax 522-4227 <br /> E-Mail:gti@geologicaltechnics.com Analysis Requested <br /> Laboratory Name and Address: <br /> Project#: Client/Project Name: r <br /> Site Address: <br /> N: '31L0;� W.'" � FEDFReport: <br /> e Order# <br /> Remarks.: <br /> T c a rk �' <br /> V - a ❑ yes No <br /> Sa dBy: (print-and ign name) o nd C] yes <br /> S Standard <br /> �." Ca <br /> 1 day, 2 day, s day <br /> ate ime Sample I.D. z F. 1�= `: Remarks <br /> All <br /> Sd=° �- e I <br /> 3&JLq- fs <br /> ti9 y 56- I.S -. 2-I <br /> -Z3 <br /> w - - - <br /> - 777 <br /> --i� <br /> ,;6, <br /> 5 <br /> Relinqui5 by: (signature) Date: Time: R ived by: (signature) ' <br /> Date: Time: <br /> Re quiff b : (signatur ' O 1De <br /> Daf` : Time: eceiv by: Wit, D t <br /> 'a t / iii, Time: <br /> R iRquished by: (signat e} Date: Time: Received by: (signature) ! <br /> Time. <br /> Date: me: <br /> Please return cooler/ice chest to Geological Technics Inc. <br /> Rev. 12/03 <br />
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