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Environmental Health - Public
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EHD Program Facility Records by Street Name
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BROADWAY
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1621
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3000 – Underground Injection Control Program
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PR0515035
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Entry Properties
Last modified
2/11/2019 4:08:16 PM
Creation date
2/11/2019 3:04:22 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3000 – Underground Injection Control Program
File Section
WORK PLANS
RECORD_ID
PR0515035
PE
3030
FACILITY_ID
FA0012021
FACILITY_NAME
WESTERN SQUARE INDUSTRIES INC
STREET_NUMBER
1621
Direction
N
STREET_NAME
BROADWAY
STREET_TYPE
AVE
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
1621 N BROADWAY AVE
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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CHAIN OF CUSTODY RECO <br /> Advanced <br /> GeoEnvironmental Inc. pate Page hof_ .� <br /> ^' <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> Client Project Manager o' <br /> ������ ��u�� `��j(,/�j21� �- Tests Regui <br /> Phone Number ? a <br /> Sample (Si e) Invoice: <br /> OV F AGE IR <br /> Project Name bvo�; ��v,f�L�.� L�3 ,U� GQ G Client <br /> Sample Location Sample Type No. of p� v <br /> Notes <br /> Number Description <br /> ;Date Time comWater rab ir Solid Conts, <br /> �,A <br /> NI IV CJIAV-AOCic7-e <br /> OAS I 0&G MPALS11THEf <br /> 18978 <br /> GOO CONDITION APPR PHIATE 18979 <br /> fiEA ' <br /> e i e lure ece+ve y: ( +gnatwe Oaie/Tin,. <br /> Re inquishe by: {Signature) Received by: (Signature) �/� Dete/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) <br /> �' "` W� �V(13 patelTime <br /> Dispatched by: (Signature) 0atelTime d La or ory b p1 Date(Tlme <br /> �'� ) ,° <br /> Laboratory Name <br /> Method of Shipment: a f <br /> Special Instructions: ` y- I hereby authoflze the erformance of the above Indioated work. <br /> ✓�`. <br />
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