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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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PR0545891
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Last modified
7/22/2020 12:15:54 PM
Creation date
7/22/2020 12:04:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545891
PE
3528
FACILITY_ID
FA0004795
FACILITY_NAME
ANTONI BROS INC
STREET_NUMBER
122
Direction
N
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
15304021
CURRENT_STATUS
02
SITE_LOCATION
122 N WILSON WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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LSauers
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EHD - Public
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t 't c t c t t t t s t t t t t c t t t t <br /> =�_= Geological Audit Service , CHAIN OF CUSTODY RECORD <br /> _ --. Services , Date Page --L— of j <br /> �7 EnYironmen�a Profess�l'ona/s <br /> 1803 West March Lane. Suite A- Stockton. California-95207-(209)956-0264 <br /> now <br /> Project Manager <br /> Client .a� j�� ; MTests Required <br /> Q-1, Ma;,.I � / <br /> Phone Number %1 <br /> of <br /> Samplers: (Signature) ��� ` Invoice: <br /> GeoAudit U' <br /> Project Name , 'G/jSsoc,dl0 � <br /> Client ❑ <br /> Sample Type v <br /> Sample Location Date Time Water Solid No. of `�� o- Notes <br /> Number Description comp crab. Air Conts. <br /> 1 — � C 13oy,K a 6 -q-q3 � Y <br /> i 30 fp -eC Io: 3',' X X <br /> e inGuis a y: (Signature) eeewe y: ignature <br /> Date/Time <br /> Relinquished by: (Signature) Reeeive Si dk dVC <br /> nature Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received for Labor ry by: Dre/Time <br /> Method of Shipment: Laboratory Name <br /> W FS 1 <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />
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