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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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[ [ [ [ [ [ [ [ [ [ f [ f [ c1 <br /> I EARTH TREATMENT SYSTEMS <br /> ENVIRONMENTAL CONSULTANTS A"i;6W turn-around <br /> CHAIN OF CUSTODY RECORD <br /> PROJECT NAME : <br /> ':�o ` Number of .� a <br /> SAMPLER (signature) : �� oa <br /> Containers/ �ra <br /> Type of <br /> Date Time Sample Location Sample <br /> pa° O <br /> Lab I.D. <br /> 2As ` LO 8 8 <br /> linquishe by : Date / Time Received by: Relinquished by : Date / Time Received by ; <br /> � ` Sas r' �/l <br /> Company: Z .,' Company: Company: Compan : <br /> Relinquished by: Date / Time Received by: Relinquished by: Date / Time Received by ; <br /> Company: Com an : Company : Com an : <br /> Relinquished by : Date Time Received by : Relinquished by : Date Time Received by : <br /> Company: Company Company: Com an <br /> NOTE: In preparing legal documents always use ink and signatures <br /> P.O. BOX 2242 (ono) 394-1041 mFRr.Fn ra ocean <br />
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