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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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CHRISMAN
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34243
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3500 - Local Oversight Program
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PR0544502
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Last modified
5/29/2019 5:04:19 PM
Creation date
5/29/2019 4:50:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0544502
PE
3528
FACILITY_ID
FA0003290
FACILITY_NAME
COUNTRY MART GAS & FOOD
STREET_NUMBER
34243
Direction
S
STREET_NAME
CHRISMAN
STREET_TYPE
RD
City
TRACY
Zip
95304-9334
APN
25318004
CURRENT_STATUS
02
SITE_LOCATION
34243 S CHRISMAN RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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t <br /> l <br /> CHAIN G • - <br /> Geological Audit Services , Inc , OF CUSTODY RECORD <br /> 1 _== EnV%/t�nmen/a Pro/essiona/s <br /> Date 26 - f <br /> Page _ 1_ of <br /> Now 1BOJ West Match Lene, Suite A • Stockton. California • 95207 -(209)g5G o2C— ,q---_— <br /> Client i <br /> Pro'ect Manager <br /> 5116 <br /> Tests Required <br /> Phone Number <br /> S�►t lers: (S' nature) <br /> Projcict Name C�UN�t/ �j� Invoice: <br /> 'a GeoAudit d <br /> L <br /> Sample SClient ❑ <br /> p Location ample Type --->�� <br /> NumberDate Time ------- No. of <br /> Description Water Solid ' <br /> rrnb_. Air Conts. Notes <br /> 31 a•-�- � l r7U JA <br /> � <br /> I <br /> f r <br /> 'n u's r atur I I <br /> oc rve y:Ly <br /> lelrnq7 <br /> ed by: (Srynature). � ase 1=a.� � C eceivgna u �) . 00 <br /> lelrnquishsd by: (Signature) <br /> Date/Time <br /> ceived by Mo <br /> Hspatched by: (Signature) bile Laboratory for lield analysis:(Signature) ~ 7 <br /> Date/Time <br /> Date/Time lleceived for Laborator b <br /> Y Y� <br /> Iethod of Shipment: <br /> Time <br /> Laborntor Name <br /> 1peclat Instructions: P1 VAWDAGJtr�ptn VT,� ��.L�_• y�-,iT I horoby nut orrz ho performance or the Above indicated work. <br /> HEAD SPACEAKENT fwrn ONER <br />
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