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ARCHIVED REPORTS XR0009816
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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ELEVENTH
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515
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3500 - Local Oversight Program
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PR0544792
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ARCHIVED REPORTS XR0009816
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Entry Properties
Last modified
11/19/2024 10:19:00 AM
Creation date
9/3/2019 11:59:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009816
RECORD_ID
PR0544792
PE
3528
FACILITY_ID
FA0004849
FACILITY_NAME
BILLS BAIT & BEACON GAS
STREET_NUMBER
515
Direction
W
STREET_NAME
ELEVENTH
STREET_TYPE
ST
City
TRACY
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
515 W ELEVENTH ST
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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Tags
EHD - Public
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tt�. tlitititit� � Itlw � t� al>Al>, �� �� I>� � !• � � 1))♦ � � � � <br /> • CHAIN OF CUSTODOECORD <br /> Geological Audit Services , Inc . Date .-ly—cl5-Page _ of <br /> �� EnYironmen1a/Prolessiona/s <br /> Ink" 1803 West March Lane, Suite A Stockton, California 95207 (209)956 0264 <br /> Now <br /> 14� <br /> Client Fill 51`*wctrT Project Manager <br /> Fob Ma rr7 Tests Required <br /> Phone Number <br /> C)-°`7 ) 956 -'o;G <br /> S,.amp,lenrsy(Signature) Invoice <br /> Invoic <br /> e <br /> �Pro ectNameS!euc ^Ts Bie�t� GeoAudd <br /> Chant <br /> p <br /> Sample Location Solid No Sample Type No of >l a <br /> Number Description Date Time Water Air Conts <br /> Comr4 Notes <br /> P <br /> 5I I - 5to��1P�Ic , sr,ufh �,Is- y yr00 X __ X0272 --- <br /> `)P I – �, N 1G X 1 � �T - ...— <br /> f _50273 1 <br /> 5 P I � , u'''i 50274 <br />� ��' 2 � I 5i�;.r,�11r �. t 5 Int/ �( � _1 � c.�►��'��rr� 5F'�- 3 1v <br /> � P - 3 , 5 x I 50275 1 - <br /> Relinquished��ignalure)� a aloe y (Signature) 5 1 ^`� r �-� T Date/Time 3� <br /> I�i a K V'[� . I _ _ <br /> Relinquished by (S+gnalure) ecery d b (Signature) fS S <br /> _ —� �.L� Y � Date/Time <br /> Relinquished by (Signalure) y <br /> iNcetOed by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time T—C <br /> for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> Special Instructions r <br /> 4i►r�T 1 hereby authorize the performance of the above indicated work <br /> i JCff!! �..,,. �t 1� T i�► <br /> };r r n ci p► r <br />
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