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FIELD DOCUMENTS_CASE 2
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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MARIPOSA
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13521
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3500 - Local Oversight Program
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PR0545534
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FIELD DOCUMENTS_CASE 2
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Last modified
3/13/2020 1:49:23 AM
Creation date
3/12/2020 11:59:56 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
CASE 2
RECORD_ID
PR0545534
PE
3528
FACILITY_ID
FA0001457
FACILITY_NAME
COLLEGEVILLE MARKET & CAFE
STREET_NUMBER
13521
Direction
E
STREET_NAME
MARIPOSA
STREET_TYPE
RD
City
STOCKTON
Zip
95215
APN
18306007
CURRENT_STATUS
02
SITE_LOCATION
13521 E MARIPOSA RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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[ [ I [ t [ [ [ t [ [ [ I t [ t [ t I <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental Inc, flame page ---�--a f <br /> 837 Shaw Hoed-Stockton,California-95218. 208 437-1008- 2D9 4 7- <br /> ��aa ( � ax{ ) 6 1418 <br /> Yt A 4*,. P t"� t Ma Tests Required <br /> Phone NumbRr <br /> . � o <br /> Samplers: Signature) ���N Invoice: <br /> •I eet�hMntt?:-- ?41U? MATO �,k-) `--� • Client <br /> Sample Location Safnple Ype No.of <br /> Date Tilene Water Solid Notes <br /> Number DeSci(ption _ Camp. Orab. Air COf11S. <br /> Rotmq+lj5 C }:, tg LILr4fr e o�Je..ur. <br /> J. <br /> L )flab <br /> Relinquished by:(Signature) ftecaivad by:(Slane,tura) <br /> RelinqWinhady;( pnature) Racalved by Uablle laboratory for field analysis:(Slpnatme) DatatTime <br /> Dispatched by.ISlonatme) DatefTim4 Fifteiv&d or ksibatatory gQate`(Tlme()� / <br /> j. <br /> Lj <br /> D Method o1 Shipment: Laborat Hams mk <br /> m <br /> Spec lal Instructions: i hereby authoriz ho perform es of ho above Indicated work. <br />
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