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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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CHAIN OF CUSTODY RECORD <br /> oqical Audit Services Inc . <br /> Geol <br /> am 1'nVM0)IM0171,77aoles,,�Ijqll,711; <br /> Date <br /> now 1803 West March Lrifin. page Of <br /> Suito A Slocklon. Clijil,)rtlin <br /> Client Pro'(ct M.-Irllqp <br /> 16 <br /> /D/J /�� l <br /> Tests Required <br /> Phone NL11111)nr <br /> San )lprs: (Si ll,-ItL)r(,) <br /> P1`0100 Name Invoice: <br /> Sample GeoAudit <br /> Client F] <br /> Location Sanitile -Tyl�c ���� / <br /> Number Description Date Time / // <br /> W No. of <br /> Water olid <br /> S. <br /> romp, C-1111) Air Collis Notes <br /> D-2- <br /> 7, <br /> �//G e o <br /> Notes <br /> Ak�* iK((14 <br /> ku:s� 11 r.! J. , - <br /> -4 <br /> -n urs atur <br /> 01'n4u# ad by: (signature). <br /> Cj <br /> 00 <br /> etrnawshsd DY: Jbignalute) Date/Time <br /> C iv0d by Mobile Laboratory for hold nr'n'Y-%'S: (Siqllilklfe) <br /> ispatched by: (Signature) Dale/Time <br /> Dat ff1e—CC1Vz-Jf T",—I_nbornlMy )y: <br />"1"00 09 Shipment: <br /> phornio N <br /> Peciel InGliucilons: IrlEff 0 01 P I LT. <br /> nrnnpY <br /> 1,11roby notil priz ho porformance of live nbove indicnied work. <br /> —AMC MAM' <br /> HEAD SPAryEAKEN! <br />
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