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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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P
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PILGRIM
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1130
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3500 - Local Oversight Program
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PR0545657
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Last modified
5/7/2020 12:24:17 PM
Creation date
5/7/2020 12:18:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545657
PE
3528
FACILITY_ID
FA0015337
FACILITY_NAME
ISLAMIC CENTER
STREET_NUMBER
1130
Direction
S
STREET_NAME
PILGRIM
STREET_TYPE
ST
City
STOCKTON
Zip
95210
CURRENT_STATUS
02
SITE_LOCATION
1130 S PILGRIM ST
P_LOCATION
01
QC Status
Approved
Scanner
LSauers
Tags
EHD - Public
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I. <br /> Advanced <br /> CHAIN OF CUSTODY RERECORD.'.. -} <br /> --_- GeoEnvironmental Inc. Daces -, _f _ . -- Page —�L— of L_ <br /> ' `� <br /> 837 Shaw Road- Stockton. California -95215- (209)467-1006 - Fax {209}467-1118 L �: U <br /> ClientProject Manager <br /> Tests Required <br /> -�k"N <br /> Phone Number i <br /> tarrrplers: (Signature) Invoice; <br /> � !` AGE <br /> Project Name �. I. -� f Client ❑ <br /> Sample Type <br /> Sample Location i Date Time Water Solid No. of /'`.. (X j / Notes <br /> Number Description Comp. Grab, Air Conts. <br /> ,; <br /> J <br /> Ainq s e y: { ignature} ----_,Receivedy: ignature DaNlTima <br /> Ret, shed by; (Signature) w Received by: (Signature) 1�4 <br /> � � DatelTime <br /> Relinquished by:(Signature) Received by Mobile Laboratory for field analysis:(Signature) `J DatelTime <br /> Dispatched by: (Signature) Date[Time Received for Laboratory b)fc) Date/Time <br /> `" L'fir 'i r3�hq <br /> Method of Shipment: Labor ory Name" <br /> 11/ co <br /> Spacial instructions: t herby ylrthyrize the performance of the ab„ Indicated work. <br /> A UC'-t'l <br /> 1 <br />
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