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ARCHIVED REPORTS XR0001600
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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CLAY
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639
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3500 - Local Oversight Program
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PR0544513
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ARCHIVED REPORTS XR0001600
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Entry Properties
Last modified
6/14/2019 1:20:12 PM
Creation date
6/14/2019 10:35:17 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0001600
RECORD_ID
PR0544513
PE
3528
FACILITY_ID
FA0024115
FACILITY_NAME
WEST CLAY PROPERTY
STREET_NUMBER
639
Direction
W
STREET_NAME
CLAY
STREET_TYPE
ST
City
STOCKTON
Zip
95209
APN
14707110
CURRENT_STATUS
02
SITE_LOCATION
639 W CLAY ST
P_LOCATION
01
QC Status
Approved
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SJGOV\wng
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EHD - Public
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� Advanced <br /> CHAIN OF CUSTOAECORD <br /> Date [�"�� "a`� _ Page ti OfZ- <br /> %'- GeoEnvironmental, Inc. <br /> 4005 North Wilson Way Stockton,California-95205-(209)467 1006-l=ax(209)467-1118 <br /> Client Project Manager! <br /> Tests Required <br /> Phone Number <br /> 46 `1 - I006 <br /> Samplers (Signature) Invoice <br /> -�� <br /> AGE <br /> Project Name VI.,57 ClctY pvuf PNTi -15 �° r Client ❑ <br /> Sample T e ° <br /> Sample Location Date Time Water Solid No of y�` �� Notes <br /> Number Description Comp Grab Air Conts .t <br /> �4 <br /> Y X � 24100 <br /> Dint - 90 -y 1 1 x 24101 <br /> 24la2 <br /> 5 5'0 1 4_'60 x X 24103 <br /> 5 65 1x X 24104 <br /> � ! �-`T7 16- 15- X X 241 15 <br /> �, I� - 35 cy'o3 X 1 x 24106 <br /> e in e y ign re Receivedy ignaturs \ - <br /> S�a�tc(aifc� <br /> Relinquish y (Signature) Received by (Signature) DalelTlme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Daterrime v6d forL,4 b ary by to p DatelTims <br /> (_WV) w. <br /> Method of ShipmentLaboratory Name <br /> L U viz s w i`pt[r. <br /> Special InstructionsVOAS O&G M L R I hereby authorize the performance of the above lndlcatedJwwk <br /> GOOD CONDITION <br /> 111111111111"'p, PROPRIATE LJ�`�v� Vi•L/ /{,l�(re /� <br /> r t <br />
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