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ARCHIVED REPORTS XR0004691
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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M
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MADISON
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423
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3500 - Local Oversight Program
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PR0544427
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ARCHIVED REPORTS XR0004691
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Entry Properties
Last modified
5/7/2019 9:21:11 AM
Creation date
5/7/2019 8:51:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004691
RECORD_ID
PR0544427
PE
3528
FACILITY_ID
FA0004581
FACILITY_NAME
CHASE CHEVROLET*
STREET_NUMBER
423
Direction
N
STREET_NAME
MADISON
STREET_TYPE
ST
City
STOCKTON
Zip
95203
CURRENT_STATUS
02
SITE_LOCATION
423 N MADISON ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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U Advanced 10 CHAIN OF CUSTOD%ECORD <br /> � ' <br /> �I� Page —A— of d— _ <br /> GeoEnvironrnental, Inc Date� ��������-� <br /> 837 Shaw Road- Stockton, California-95215 - (209) 467-1006- Fax (209)467 1118 <br /> Client Project Manager <br /> Tests Required <br /> Phone Oumber <br /> (-i6"'k) tj 6-7 �004E> 411 <br /> Samplers (Signature) V Invoice <br /> rC� AGS <br /> Project Name �1„ A� �1SO� <br /> Sampie Type Client ❑ <br /> �� e <br /> 5Samplet acarian Date Time Wa $ Solid No of � <br /> f�a Q� � / Notes <br /> Number Description Air Conts rt <br /> Comp Grab <br /> AW�tt>-S /vkW 2 X <br /> k�W 4oaa3 W �a�3�°3 D 95s X K K X <br /> �W5 4fa3faa� 1 "i <br /> 0 'So 0 <br /> to aa3 _ <br /> def uas e y ignature ece ve y ignattire Date/Time <br /> In 3o Q3 icon <br /> Relinquished by (Signature) Received by (Signature) Dateltime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datelrime <br /> Dispatched by (Signature) DatelTime Ra r Laborato / atelTime <br /> Method of Shipment aEC'p SEALED&lNACT V!A is 'Q��r� Lab°ator ' a <br /> C _V overrY\i h Nuc ate( <br /> Spacial Instructions <br /> I hereby au horize the pertormance of the above Indicated work <br /> ICF1t' I <br /> HEAL]SPACE ABSENT CONTAINERS <br /> DECHLORINATED IN LAB PRESERVED R4 LAB <br /> PrlFS1'RVA-MOW <br /> I <br />
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