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ARCHIVED REPORTS XR0006117
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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1876
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2900 - Site Mitigation Program
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PR0542421
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ARCHIVED REPORTS XR0006117
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Entry Properties
Last modified
6/21/2019 1:21:41 PM
Creation date
6/21/2019 10:45:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006117
RECORD_ID
PR0542421
PE
2950
FACILITY_ID
FA0024377
FACILITY_NAME
COUNTRY CLUB BLVD/295950
STREET_NUMBER
1876
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12319101
CURRENT_STATUS
01
SITE_LOCATION
1876 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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• • i <br /> I Advanced 0 CHAIN OF CUSTODY RECORD <br /> eoEnvixanment�l, Inc. Date----, -� _r_e � e of <br /> -'` <br /> 837 Shaw(Road-Stockton,California-85215- (209)467.1005- Fax (209)467-1118 <br /> Client `� Project A9anager <br /> I t � S�J(A � Tests R t1lPC-t9 <br /> Phone Number t f / / <br /> Samplers: (Signature) Invoice: <br /> Project Name Cavil. 01-1� � � �; � /��;r � �� AGE �- <br /> � . '- t , / Client ED <br /> Sample LocationSample Type <br /> Number Description Cate Time Water Solid Na.of � �! �f ��r/�� �, �� / Notes <br /> Comp. Grab, Air Conts. <br /> JT <br /> get, s e y: 5sonature ecgSva y: ngnature - prfaj7imo <br /> Igelin +fished by: (Signature) Received by: (Signature) r r" DaterTlma <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis:(Slgnatuto) � Dat4(rims <br /> Dispatched by: {Signature) Dote/Timo Roccivgtf r 'aborato]r�' by: f} tClritrt® w <br /> Method of Shipment: j �k ,r r A r Loboratory Na <br /> Special tnatructionc t _ I ftaro thorise tits parformanco of the abovo indicated work. <br /> 9 <br />
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