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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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3500 - Local Oversight Program
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PR0545788
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Last modified
6/15/2020 12:04:31 PM
Creation date
6/15/2020 11:59:16 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545788
PE
3528
FACILITY_ID
FA0003617
FACILITY_NAME
CAL WEST CONCRETE CUTTINGS INC
STREET_NUMBER
1153
STREET_NAME
VANDERBILT
STREET_TYPE
CIR
City
MANTECA
Zip
95337
APN
22119031
CURRENT_STATUS
02
SITE_LOCATION
1153 VANDERBILT CIR
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, .Inc. - Date 04-to"ir-oil Page l or I <br /> V;•. of Monheni Calijnrnia <br /> 1803 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)956.0700 - <br /> ClientProject Manager <br /> C41 e)eaT Ccr.rre} E _ T. C,.- Tests Required <br /> Phone Number <br /> 5ID- oabLl_ <br /> Samplers: (Signature) Invoice: <br /> Aroject Name t' " AGE [v]� <br /> 'n CW C4 Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Solid No. °t /Q�Sl �4' Notes <br /> _ Comp. Grab. Air ContS. <br /> GW — )ELL# I�j -o 0 ot'.bo 7C 3L^"e� ,c <br /> e mgws a y: ignatwe Mecorved-Ey: ( ignatwa <br /> QD <br /> Date/Time <br /> 1 <br /> elinquisl d bl (Signatmo) J rnV 1 ` �(A l'Vyg <br /> Received by: (Signature) - - Datellime <br /> netinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) - Date/Time <br /> Dispatched by: (Signature) Date/Time - no for Labor y by: Date/Time <br /> �✓ v Y-/v ac, <br /> Method of Shipment: Le oratory Name <br /> —�� �sJf-aN �rHT _ CAs-71 I CC4 <br /> Special Instructions: - I hereby authorize the performance of the above Indicated work. <br />
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