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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2024
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3500 - Local Oversight Program
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PR0001053
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Last modified
5/17/2019 9:51:35 AM
Creation date
5/17/2019 9:32:18 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0001053
PE
3528
FACILITY_ID
FA0004084
FACILITY_NAME
CLARK WELL AND EQUIP CO
STREET_NUMBER
2024
Direction
E
STREET_NAME
CHARTER
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
2024 E CHARTER WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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Tags
EHD - Public
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CHAIN OF CUSTODY RECORD. <br /> -= Geolo Ica Audit- SeFVices , I nc . Date r��z� qyt Page - <br /> -r <br /> of <br /> �� EnYironmenta ProfessAvna/s <br /> LOW 1803 West March Lane. Suite A• Stockton. California-95207-(209)956.0264 <br /> r <br /> Client Project Manager Tests Required <br /> Nrk 1�Ic I Slit ly Waal ker <br /> Phone Number <br /> Samplers: (Signature) Invoice: <br /> GeoAudit9 <br /> Project Name � K VIII Client ❑ <br /> „ � +wr Sample Type <br /> ---Sample location Date Time Water Solid No. of Q Notes <br /> Number Description comp. Gran. Air Conts. f� <br /> I X • 9V/� -DDCo Y.? <br /> $t_fit t sir.. �,e-� 11'• X X <br /> 00 YJ <br /> IX I XI Co&gq <br /> 8.2' 6` ori 2 -liar feed 2= X X DD CoB� <br /> y s 46 NO <br /> 3:2-s i X 00 69 <br /> �eT` rs a rgiratu feceive y: ignatura !� tel7imeTAT <br /> , <br /> CWT <br /> Rslinqu (Signature Need( <br /> ad by: (Signature) Received by: /"' C l Data(Time /A0 <br /> Relinquished by: (Signature) Received by Mobile Laboratory-row field a sir.(Signature) Qatal7ime <br /> Dispatched by: (Signature) DetelTime Received for Laboratory by.: Datel7ime <br /> F <br /> Method of Shipment: ° Laboratory Name <br /> Specll Instructions, hero y authorize t a performance of the above indicated work. <br /> o 27 <br />
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