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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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B
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BYRON
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12750
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3500 - Local Oversight Program
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PR0544143
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Last modified
2/13/2019 2:32:52 PM
Creation date
2/13/2019 2:11:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0544143
PE
3528
FACILITY_ID
FA0004719
FACILITY_NAME
CALDRONS GENERAL STORE
STREET_NUMBER
12750
Direction
W
STREET_NAME
BYRON
STREET_TYPE
RD
City
TRACY
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
12750 W BYRON RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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CHAIN OF CUSTODY RECORD•; <br /> =_�-_= Geolo ical Audit Services , Inc . <br /> v= <br /> EnVirnnmonta Protossionais. Date Page _1_ of 3 <br /> =.- <br /> 1803 West March Lane, Sulfa n- Stockton, California-95207-(209)956-0264 <br /> Z�l�t GASr� <br /> Client 6Ll7ww.5 Project Manager <br /> f306 Tests Required <br /> Phone Number <br /> 450�-026 4-- <br /> Sample s: (Signature) Invoice: <br /> Project Name GeoAudit <br /> `, Cli <br /> Sample Location Sample Type No. of \`� , <br /> Number Description Date Time — Water Solid Notes <br /> Comp. Gral,, Air Conts. <br /> b �I <br /> SPI- Z I,4�f <br /> c TLS <br /> SQL-z <br /> Z <br /> 5 <br /> PA-11 Z:ZS I �( x �>� ��4-L <br /> qurs a y: ,gnat r e er c y: r n ure �i1t� <br /> Dale/Time <br /> in uished b rJ J U ;v/v <br /> q y: (Signature) Received by: (Signature) AJ Dale/Time <br /> Relinquished by: (Signature) CSV t�j0 <br /> Received by Mobile Laboratory for field analysis: (Signature) Dale/Time <br /> T?M L <br /> Dispatched by: (Signature) Data/Time Received for Laboratoryby:y: Ile/Time <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: - r,•i,,__ �„1_ .._�-- <br /> GOOD Gf NVnIGrJ_-/ AP' 'RCWPIATF / � 1 hereby authorize the performance of the above Indicated work, <br /> r - <br /> LAIV <br />
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