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ARCHIVED REPORTS XR0000745
Environmental Health - Public
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EHD Program Facility Records by Street Name
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B
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BEVERLY
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104
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2900 - Site Mitigation Program
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PR0540667
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ARCHIVED REPORTS XR0000745
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Entry Properties
Last modified
2/8/2019 10:05:26 AM
Creation date
2/8/2019 8:42:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000745
RECORD_ID
PR0540667
PE
2960
FACILITY_ID
FA0023252
FACILITY_NAME
WELDON CHURCH PROPERTY
STREET_NUMBER
104
Direction
W
STREET_NAME
BEVERLY
STREET_TYPE
PL
City
TRACY
Zip
95376
CURRENT_STATUS
01
SITE_LOCATION
104 W BEVERLY PL
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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- � F <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GecEnvironmental Inc. Date 7 2V- Page of <br /> of Nnrtherrr Calijornra <br /> i 1603 West March Lane,Suite A-Stockton, California-95207-(209)956-0264-Fax(209)958-0700 i�v �`7 �t�5 /7 <br /> Client Project Manager <br /> Vests Required <br /> � r' <br /> ' Phone Number <br /> f <br /> Samplers: (Signature) Invoice: <br /> Project Name r <br /> AGE <br /> 0)0/Ido;j Client ❑ <br /> Sample Type <br /> Sample Location No. of <br /> Number Description Date Time Water Air Solid Conts. Notes t <br /> ��rr�� Comp. <br /> W —�1J1 <br /> ' 2.5` <br /> f* r <br /> i ; <br /> _e i_tvqu a y: (Signature ec e : i,�/nature <br /> Relinquished by: (Signature) Re6dwfa by: (Signature) Dale/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) <br /> Date/Time Received for Laboratory by: DaterTime <br /> Method of Shipment: Laboratory Name <br /> Special Instructions: I hereby author a the performance of the above indicated work. <br /> 1 �"a <br /> PiG h .Wf . t <br /> AM <br /> IN"An SPArF ARCFhi'C r4mm illy". _. <br />
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