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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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Advanced <br /> CHAIN OF CUSTODORECORD <br /> Date C103 Page 2 oto <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006 - f=ax (209)467-1118 <br /> ClientCom_ R�� Project Manager Tests Required <br /> one Number <br /> -.00,� tA 67--Icy a oN <br /> Samplers (Signature) Invoice <br /> Project Namer-- �,, _ L'? AGE <br /> `-� e- PcASO� ; \r Client ❑ <br /> CS <br /> Sample Location Sample Type Solid No of Notes <br /> ©��,(� <br /> Number Description Date Time Water Air Conts �' (e- <br /> Comp (arab �rC� „ <br /> iwtokto Dc31AAW t 10(34o r `!Z 1� X X Y <br /> W GC\ � 33 I zvs K K k X <br /> kw,lR <br /> w 7PA o o MW -Lo A +° ��°� 133$ _ X X Y X <br /> * 3O1c' 3 X - — — <br /> Raltilq4shed by Signa re tcetdb rgnaturn - �6 �ba��i a Oil <br /> 16 <br /> Relinquished by—(Slgnsturer Received by (Signature) <br /> Datn ime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signalurlr) /! Date/Time <br /> Dispatched by (Signature) Datefrrme Rec i r Laboratar / D teffime <br /> Method of Shipment Laboratory Name <br /> CG1 �� <br /> Special Instruatlons I hereby authorize the performance of the above indicated work <br />
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