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ARCHIVED REPORTS_XR0008885
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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V
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VAN BUREN
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424
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3500 - Local Oversight Program
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PR0545786
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ARCHIVED REPORTS_XR0008885
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Entry Properties
Last modified
6/1/2020 2:36:15 PM
Creation date
6/1/2020 2:07:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008885
RECORD_ID
PR0545786
PE
3526
FACILITY_ID
FA0004969
FACILITY_NAME
CHASE CHEVROLET
STREET_NUMBER
424
Direction
N
STREET_NAME
VAN BUREN
STREET_TYPE
ST
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
424 N VAN BUREN ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
LSauers
Tags
EHD - Public
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( Advanced CHAIN OF CUSTODY RECORD <br /> �-- GeoEnvlronmental, Inc -Date :- 13 Ipage � of 2 <br /> 837 Shaw Road - Stockton, California- 95215 (209)467 1006 - Fax (209) 467-1118 <br /> Clientr <br /> Pr <br /> Ma;ag <br /> s Required <br /> _ P ne Number G' <br /> Project Name BfS <br /> Se Igneture} invoice <br /> kAG f; <br /> (-� Client <br /> Sample Location Sample Type 'Xr x _ <br /> Number Description Dale Time Water b Air Solid font/ '�, r �t 4 ' 4_ <br /> o Camp <br /> -E,a <br /> ma <br /> 7=77i5 -6 <br /> } <br /> /S// s .y <br /> 7 ; x <br /> 0 ^CMZ <br /> fa W -0xw w <br /> 4ellint a ignatur e we y ignatu� j <br /> '] CN 1�t n � f ate/Time <br /> kel�nqulshed by (Signatur 1� 1 1 1 U _ r Or �hG� <br /> Recwved by (Signature)r <br /> Relinquished by ut1<L r ,4 <br /> Apewed by M bike La oraloi y for field analysis (Signature) z� � z e <br /> F v <br /> Dispalched by (sNii 90ACE KrR'SIENT_ _ _I Caij J Date/Tima Received for Laboratory by <br /> Date/Time <br /> Method of ShipmentLaboratory Na o - <br /> �.�C✓ <br /> Spec�af tnstrucuona I hereby authorize pert mance of the above indicated wurl <br /> Cry fer f '04PfVenl Vi Q-- C ntr�ey1S �e _ <br />
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