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ARCHIVED REPORTS XR0000756
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 XR0000756
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Entry Properties
Last modified
2/8/2019 10:16:42 AM
Creation date
2/8/2019 9:19:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000756
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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�_ l_ l_ � � i� llllllll- Illlllllllllllll' IIIIIIIIIIIIII 11111111111111 � 1- � <br /> Advanced CHAIN OF CUSTODY RECORD <br /> (9 Page of . <br /> --- GeoEnyiironmental, Inc. " <br /> Date <br /> 837 Shaw Road- Stockton, California-85215-(209)467-1006- Fax (209)467-1118 <br /> Client Pr ja Ma ge <br /> Tests Roulred <br /> Toe tiumber <br /> Sam rs: (Si nature) Invoice: <br /> Project Name ), l l n AGE <br /> Client ❑ <br /> Sample Location Sample Type No. of 1.4Number Description Date Time Water Solid Notes <br /> Comp. Grab. Air Conts. <br /> ftile -dI �7v" 3 1 1 <br /> Z6 37 <br /> I :6.7879 I <br /> 1 <br /> 3 a i 6788Q <br /> 678 -�.:... ._,. i <br /> ► 1 <br /> 2 ;. <br /> d k 6 78 .2 <br /> — <br /> II sl <br /> 32Z67.8.8 4 <br /> e en urs a Rece a y: isignaturaT I <br /> Relinquished by: ( igna u►e) Received by: (Signatur Date/Tim <br /> 1 e ESERVA1I01 <br /> Relinquished by: (signature) GOOD CONDITION "'GcelvWfflAfJaborato for field analysis:(Signature) Date/Time <br /> Dispatched by: (Signature) -- Date[TimIF I Received for laboratou by: te`lTime <br /> Method of Shipment: Lab story Name <br /> ��.T-*—L <br /> Special Instructions: se I hereby rize the Iverfolmance of the above indicated work. <br /> A ti <br />
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