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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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EIGHT MILE
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11540
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2900 - Site Mitigation Program
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PR0506051
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Last modified
7/10/2019 12:26:05 PM
Creation date
7/10/2019 10:29:10 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0506051
PE
2950
FACILITY_ID
FA0007171
FACILITY_NAME
HOLIDAY HARBOR/INTREPID MARINE
STREET_NUMBER
11540
Direction
W
STREET_NAME
EIGHT MILE
STREET_TYPE
RD
City
STOCKTON
Zip
95219
APN
07119004
CURRENT_STATUS
02
SITE_LOCATION
11540 W EIGHT MILE RD
P_LOCATION
99
QC Status
Approved
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EHD - Public
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rr � � N■r r �■ � � r � r r rr � ■r � � ear r <br /> Chain-of-Custody Number: <br /> SEACOR Chain-of-Custody Record <br /> Field Office:- � hr `' C r'S �'o Additional documents'are attached,and are a part of this Record. <br /> Address: '74 Yew -> f C O;z Q Job Name: P !P C <br /> Location: <br /> CA <br /> - - o <br /> Analysls Request <br /> Project#SO 3 - QO/`� Task# <br /> Project Mena er -r_ _OLU h At 4 rh r• <br /> 4 <br /> �7 m <br /> Laboratory x o v - -.. <br /> Turnaround Tim a a <br /> Sampler's Name c S <br /> ID <br /> Sampler's Signature a C" <br /> Sample ID Date Time Matrix s H t� z �Fd a 1-r- a 2 P �-- nstr cComions z' <br /> ID- <br /> 6 �4d <br /> g <br /> Special Instructions/Comments: Relinquishe by; Received by: <br /> Sample Receipt <br /> • Sign Sign t' ha Total no. of containers: <br /> ` Print Print Chain of custody seals: <br /> Compan Company Rec'd.good condition/cold: <br /> Time DatJ T!Yd TimDate 5 Conforms to record: <br /> Relinquished by: Received b <br /> Sign Sign _ Client: <br /> Print Print " <br /> Client Contact: <br /> Company Company � ,�� <br /> Time Date Time 10U`� Date -l0 Client Phone: <br /> u�onanmEe nw.ram <br /> + Date: Page of <br />
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