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ARCHIVED REPORTS_XR0003758
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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H
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HAZELTON
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375
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2900 - Site Mitigation Program
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PR0540905
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ARCHIVED REPORTS_XR0003758
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Entry Properties
Last modified
2/3/2020 9:55:07 PM
Creation date
2/3/2020 9:00:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003758
RECORD_ID
PR0540905
PE
2960
FACILITY_ID
FA0023406
FACILITY_NAME
SIERRA LUMBER MANUFACTURERS
STREET_NUMBER
375
Direction
W
STREET_NAME
HAZELTON
STREET_TYPE
AVE
City
STOCKTON
Zip
95205
APN
147120808
CURRENT_STATUS
01
SITE_LOCATION
375 W HAZELTON AVE
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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� a>!tr ttttttttttt■ ttttttttttt t� tfa� tiiiiiiiiil� tf� ttfiw tfi � tI• � � I• � � i• <br /> Lpt-- <br /> Advanced CHAIN OF'CUSTODY RECORD <br /> GeoEnvironmental, Inc p g��7 Date Page ()f <br /> f <br /> 897 Shaw Road- Stockton California- 95215- (209) 467-1006 - Fax (209) 467-1118 <br /> Client Pro anag <br /> a r <br /> Tests Required <br /> P ne umber <br /> Sa ers (Signature) Invoice <br /> Project Name AGE fa' <br /> F?-t^ LClient ❑ <br /> Sample Location Sample Type s Q <br /> Number Description <br /> Date Time Water Atr Solid Con0 Notes <br /> Comp Grab <br /> ts <br /> 4/ M 1A) l 4 i - - i - - X , <br /> 50� <br /> d3i — <br /> ' lit I v -� <br /> e Inqu a e y (Signature) ece ve y gnature 0a (Time <br /> Relinquished by (Signature) Recelved by {$€gnature �L66 <br /> <) <br /> rOAfls did <br /> 11iETAL� ate(TI m e <br /> Rahn Sure) APPROPRIATE Received by Mobile Laboratory for field analysis (Signature) DatalTime <br /> MEAD 9pACF ABSENT_ <br /> Dispatched by (Signature) Date/Time Be I or Labgra� y e(Time <br /> d% �� 021 QO�Z r7 Od� <br /> Method of Shipment Laboratory ttamy <br /> Spacial Instructions MST,tIB OTHERI hereby authorize tho pert mance at tha above Indicated work <br /> OttCQ <br /> GOOD CONDITION APPROPRIATE <br /> BEAD SPACE ABSENT CONTAINERSAf— <br />
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