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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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 /> Geological Audit Services , Inc . Date ��y-9 - 2-- <br /> 141803= Ent'ironmenla Professiona/s Page Z- of <br /> = -.- _ <br /> Wesl Match Lane, Suite A-Stockton, California-95207 -(209)956-0264 <br /> �� CO <br /> Client 4L©9c-)?J S Project Manager <br /> Tests Required <br /> Phone Number <br /> �Xl rSCo-vL�n - <br /> Samplers: (Signature) Invoice: <br /> Project Name GeoAudit �- <br /> C�'Lb�ot�l S �'f��fG�T -� �T� Client <br /> r-1 <br /> Sample Location Sample Type <br /> - <br /> Number Description Date Time Water Solid No. of �, <br /> -7 Comp. Grab. <br /> Air Conts. % Notes <br /> 517 "Z (L_q/� ( t/ t/ /Go h s r TIE 1 <br /> �7��1�I1_E 4 It-� 1 i �l /t Fo <br /> r �urs�, y: ( rgnature tRoe* <br /> i n lure <br /> LED 4 CDate/Time <br /> linquished by: (Signature) %�/ �- ?'TC-) <br /> d by: (Signature) .-T� Dale/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br /> J <br /> Date/Time <br /> Dispatched by: (Signature) Date/Timo Rieecevor Lahby: <br /> Dole/Time <br /> Method of Shipment: rf, T <br /> r �'3, (ilR r 11,11 tl i� �•, Laboratory Name <br /> : I�Tt._„��' <br /> `.fit t !'ICS i=ZL <br /> Species Instructions: 'i <br /> EV <br /> WMAMT <br /> Z 7 <br /> I hereby authorize the performance of the above indicated work. <br />
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