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ARCHIVED REPORTS XR0004801
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 XR0004801
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Entry Properties
Last modified
5/7/2019 9:27:40 AM
Creation date
5/7/2019 9:13:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004801
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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ww w w w■ ww ■■■ ww ww ■w wr ww ww iw r[. ww ww w� <br /> Advanced <br /> GeoEnvironmental' Inc. <br /> CHAIN OF CUSTODY RECORD <br /> .�. <br /> Date Page _�_ of—_I <br /> of Nr3nlrenr Calrfrinrra <br /> 1803 West March Lane Suite A Stockton California 95207 (209)956-0264 Fax(209)956-0700 <br /> 7a5 Cs <br /> Client � � Project Manager <br /> K t v f v, p4 h) Tests Required <br /> Phone Number <br /> 0�0q) q5-6 0169 <br /> Samplers (Signature) Invoice <br /> Project Name L e t v r u I �T _ Mad � /- - AGE Q <br /> Sample Location Sample Type Client ❑ <br /> No <br /> Number Description Date Time comp Water Grrab Air Solid Contsf < Nates <br /> r <br /> , <br /> ! <br /> -LI 51 - Y, 30 X y B09fi4--- <br /> LA 60965-- <br /> 1 � <br /> to I X 60966 <br /> 60967 <br /> ! tJ-U 60968 <br /> r <br /> e u, urs e y ( ignaturey <br /> � v Y i9r1a re <br /> L�� Dale/Time <br /> Relinquished by (Signature) LC• �f� C�,,,�y "J,R r � �+ (} <br /> ecerved by (Signature) r/`7�} t ( ° r 7 <br /> Date/Time <br /> Relinqutshed by (Signature) <br /> Received by Mobile Laboratory for herd analysis (Signature) <br /> DatelTrme <br /> brspatched by [Signature} Date/Time <br /> Recurved for Laboratory by <br /> Date/Time <br /> Method of Shipment /] ?� <br /> �-dF2' ' �-_ ( I_„ GI- Laboratory NameSpeo,ar InctionsHER <br /> 4�o�U (�{r M (Ant y { t r <br /> ! <br /> T hereby authorize the performance of the above Indicated work <br /> [CP./T <br /> HEAD SPACE ABSENT,, CONTAINERS <br />
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