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ARCHIVED REPORTS_XR0007226
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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88 (STATE ROUTE 88)
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13975
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2900 - Site Mitigation Program
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PR0522057
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ARCHIVED REPORTS_XR0007226
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Entry Properties
Last modified
11/20/2024 9:21:19 AM
Creation date
9/5/2019 2:17:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007226
RECORD_ID
PR0522057
PE
2950
FACILITY_ID
FA0015024
FACILITY_NAME
USA GASOLINE #3756
STREET_NUMBER
13975
Direction
E
STREET_NAME
STATE ROUTE 88
City
LOCKEFORD
Zip
95237
APN
01908014
CURRENT_STATUS
01
SITE_LOCATION
13975 E HWY 88
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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11� � � 11�11 ll� r gab <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date A A--1 4 Page -_of ---- + <br /> of Nnr7hcnt Caltfomia <br /> 1803 West March Lane Suite A Stockton Cattforrna 95207 (209)956-0264 Fax(209)956-0700 (0 II 0 <br /> Client Be F� i Project Manager Tests Required <br /> K4vi M r-Kfbb44 <br /> Phone Number <br /> (zoa) 956 -0;6 <br /> Samplers (Signature) Invoice <br /> ProjectName , �� <br /> �.0 C ��� e N ��{p � �-�u AGE [� <br /> Client EJSample location Sample Type �/ <br /> Date Time Water Solid No of q� Notes <br /> Number Description comp crab Air Cants <br /> 2 _63016 ai <br /> ft x u �i Rr'y'LtF'�ih.wi a r s t� <br /> 1 <br /> 01G 1 W 11"Ir,"' <br /> OPRIAIE <br /> }IAD SPACE ABSENT co AIPiff{S <br /> Relinquished y (Signature) a tv y rgna ��� Date/Time <br /> "^ �' is 3 4-q-106.3a <br /> Relinquished by (Signature) cerved by (Signal re) <br /> DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Trme Received for Laboratory by Date/Time <br /> Method of Shipment `q Laboratory Name <br /> G aYorni �T— �e d 6 Sid P1CCard h!IL <br /> Special InSITL(a+ons I hereby authorize the parlormance of the above indicated work <br />
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