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ARCHIVED REPORTS XR0004796
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 XR0004796
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Entry Properties
Last modified
5/7/2019 9:26:29 AM
Creation date
5/7/2019 9:12:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004796
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
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EHD - Public
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i <br /> s <br /> � CHAIN OF CUSTODOECORD <br /> Advanced � I <br /> �. GeoEnvironmental, Inc. <br /> Date 54J7. Page <br /> of Northern Califonua <br /> 1803 West March Lane Suite A-Stockton,California-95207-(209)956-0264 Fax(209)956-0700 8coQs; <br /> Client <br /> Prosect Manager Ke-V( Mc kr bf ,hTests Re uired <br /> Sa lUf 1 <br /> Phone Number C 2,C) <br /> I) 156 -02-6q <br /> 56 `02-6, ` �\ <br /> Samplers, (Signature) , Invoice <br /> AGE <br /> Project Name S q114 Client El <br /> Sample Type ------ <br /> Sample Location Date Time Water Solid No of l <br /> Number Description comp Grab Air Conts ' _1, = 76237 <br /> ,—_ <br /> �r <br /> r <br /> i'iV <br /> v76238C-r 17 <br /> 76239 -JAI1 <br /> 14� 1 :1,% -,J ,762461 <br /> L4 1 - k <br /> 55t � 7624f : <br /> S t <br /> J 1 i.,ir i <br /> i <br /> ,l , 76243 <br /> "v ei <br /> 1� [ Data/Time <br /> e mqui r e y a Lure v y ignatur � <br /> Relinquished by (Signature) I Re ed by (Sign ure) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) n Date/Time Received for Laboratory by Dale/Tlme <br /> Method of Shipment Laboratory Name M <br /> f �ole� icer�� f AA Ct lf;�C04( <br /> `�-P�9Ied TJA -�G - 1 hereby authorize the perlorma ce of the above indicated w rk <br /> Special Instructions i <br /> nn x <br /> vii CONDCTI IN.ql T r <br /> I, 1r,MPF As0T;-1 CONTAINEPS .� <br />
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