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FIELD DOCUMENTS_CASE 1
EnvironmentalHealth
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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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t [ L L L L L L L L [ [ C [ [ L [ C <br /> 1 %5 EARTH TREAT - SYSTEMS turn-around <br /> ENVIRONMENTAL CONSULTANTS- o <br /> PROJECT NAME: CHAIN OF CUSTODY RECORD,1\ <br /> 3o f Number of yy a b <br /> SA <br /> MPL <br /> ER (signature) : Containers/ �'p,yy �o <br /> o ti <br /> Type of <br /> Date Time Sample Location Sample �� a r <br /> Lab I.D. <br /> l�-Z►-�5 1!'._37Rm '�61 - G62i F8 <br /> s c eve <br /> 'S3 Aw-, 61 -O 61 M 6 <br /> Z•. '),oI - C' ,21tS ';_5 - A r AW, �• (�(Szx-17 <br /> tZ_25?m 36 1- o6-2186 - (o 10' Y( <br /> Relinquished by: Date / <br /> ET5 C►�.Q 3.o�r' Time ive by: Reli quitshby: Date / Time � eceived CwbQy,� <br /> : <br /> c,-z.-/ / <br /> /''\ cG1/ y; <br /> Company: n : �� Company: G Company <br /> Relinquished by: Date / Time Received by: Relinquished by: Date / Time Received by: <br /> Com an : Company: Company: Company: <br /> Relinquished by: Date Time Received by: Relinquished by : Date Time Received by : <br /> Company: Company Com an : Company: <br /> NOTE: In preparing legal documents always use ink and signatures <br /> P.O. BOX 2242 (209) 384-1041 MERGED, CA 95340 <br />
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