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FIELD DOCUMENTS_CASE 1
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545492
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FIELD DOCUMENTS_CASE 1
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Last modified
3/13/2020 11:57:10 AM
Creation date
3/13/2020 11:10:13 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
CASE 1
RECORD_ID
PR0545492
PE
3528
FACILITY_ID
FA0000309
FACILITY_NAME
MCHENRY STATION & MINI MART
STREET_NUMBER
1405
STREET_NAME
MAIN
STREET_TYPE
ST
City
ESCALON
Zip
95320
CURRENT_STATUS
02
SITE_LOCATION
1405 MAIN ST
P_LOCATION
06
P_DISTRICT
005
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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EABIH TREATMENT Y T <br /> ENVIRONMENTAL CONSULTANTS, 0� SNOW turn-around <br /> CHAIN OF CUSTODY RECORD <br /> PROJECT NAME : <br /> Number of <br /> SAMPLER (signature) <br /> n '^� SG� Containers/ "F ( <br /> t-t Type of <br /> Date Time Sample Location SampleX� v� <br /> Lab I.D. <br /> (o-21-68 j1:37� `�,n) - G621E8 - ' A sc vt <br /> ZI 21FSS <br /> t• << '1 7rh of - t. t5� <br /> ,� t (=3t,i►n 301 - 2t�c- j - IS ` �( _ ,S-�"�ce <br /> t 1' Z:25-7)m _3o I - 0h-21£6z, - <br /> t\ \t x.14-T')m _'�n{ -c) <br /> Relinquished by: Date / Time R ceive by: Reliquishe by : Date / Time Received by : <br /> I C �, zr �� � � � <br /> TS '� G z/ :y C - <br /> Company: Com an : C ' Company: <br /> Relinquished by: Date / Time Received by: Relinquished by: Date / Time Received by: <br /> Company : Company: Company : Company : <br /> Relinquished by : Date Time Received by: Relinquished by : Date Time :Received by : <br /> Company: Company Company: Company: <br /> NOTE: In preparing legal documents always use ink and signatures <br /> n n nnv nolA1$ (..n�1 iPA_in41 mrRr;=n rA gS340 <br />
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