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FIELD DOCUMENTS
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2900 - Site Mitigation Program
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PR0545496
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Last modified
3/24/2020 3:28:51 PM
Creation date
3/24/2020 3:05:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545496
PE
2957
FACILITY_ID
FA0003564
FACILITY_NAME
BLUE STAR
STREET_NUMBER
4040
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15727503
CURRENT_STATUS
02
SITE_LOCATION
4040 E MAIN ST
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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�? Advanced CHAIN OF CUSTODY RECOT , N <br /> m <br /> -- GeaEnvironmental, Inc. oats Page 1 N <br /> 837 Shaw Road- Stockton, California-95215• (209)487-1008- Fax (269)467-1118 ;rI z 4 ) w <br /> Client Pr 'ea Manager <br /> Tests Required <br /> Phone Number <br /> N <br /> CD <br /> Samplers: (Signature) LOIrnrolce: <br /> Project Name bl � S AGE ( <br /> client ❑ <br /> Sample Location <br /> Sample Type No. ofe <br /> Number Description Date Time Water Air Solid Corps. Notes <br /> comp. (arab. <br /> 3 V ✓ C <br /> 3 j3 <br /> LO <br /> LO <br /> /006 o <br /> o <br /> r2, °D �4 <br /> Relinquished y: (signature)H ece ve y: (Signature) Datefrlme <br /> Relinquished by: (Signature) Received by: (Signature) Date rime <br /> Relinquished by: (Signature) Received by Mobiis Laboratory for field analysis:(Signature) Date/Tlme <br /> Dispatched by: (Signature) Dale/Tims ecevad tar Laboratory y: Date rime <br /> VZ <br /> ]Method of Shipment: Laboratory tip • D <br /> CAL 7 M <br /> m <br /> Special Instructions: I hareby authoriZ• the performance of the above indicated work. <br /> Ln <br />
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