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ARCHIVED REPORTS_XR0008906
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_XR0008906
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Entry Properties
Last modified
6/1/2020 2:32:11 PM
Creation date
6/1/2020 2:23:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008906
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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'� L___.' � tl>>>>l� II• II• Il, � tl• � � � <br /> I <br /> Advanced CHAIN OF CUSTO ECORD <br /> --=_ GeoEnvironmental, Inc Date Page of�. <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467-1118 <br /> Client Project Manager , 11 Tests Required <br /> Phone Number q6 7 <br /> \ <br /> Sampters (Signature) Invoice <br /> AGE/ ly <br /> Project Name ffww ,�u�/ u� e ❑ <br /> Uq � Client ' <br /> Vr QS e— �u�t- h C <br /> Sample Location Notes <br /> Sample Type No of / 4, <br /> Date Time Water Sajid �' , <br />+ Number Description Comp Grab Air Conts <br /> 10576X\ I J <br /> ,- <br /> Lf x 10W <br /> e tnqui y { , nature ecer y ignature „ ate me <br /> r�z ��� , <br /> � - Sf s � o <br /> Relinquished by (Signature) ec d by (Signs ure) DatefTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Time <br /> F <br /> Dispatched by (Signature) Date/Time Received for Laboratory by - Dale/Tlme <br /> Method of Shipment Laboratory Name <br /> LA oU�,r►�l k T � .t <br /> Special Instructions I hereby authorize the performance f the Yove Indicated work <br /> VOA s o&c METaIs oTHEA ��,-�,� �zAu�� <br /> DSD C(lydDITION ---_, /APPROPRIATE <br /> TAN[-Rs <br />
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