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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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BYRON
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12750
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3500 - Local Oversight Program
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PR0544143
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Last modified
2/13/2019 2:32:52 PM
Creation date
2/13/2019 2:11:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0544143
PE
3528
FACILITY_ID
FA0004719
FACILITY_NAME
CALDRONS GENERAL STORE
STREET_NUMBER
12750
Direction
W
STREET_NAME
BYRON
STREET_TYPE
RD
City
TRACY
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
12750 W BYRON RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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CHAIN OF CUSTODY RECORD <br /> Geological Audit Services , Inc . Date ) � -r-R`� Page o,� <br /> =�= Environments plomssiona/s <br /> t <br /> - 1803 West March Lane,Suite A-Stockton, California 95207 •(209)956-0264 t <br /> r. r <br /> 429'2'3 t <br /> ClientProject Manager <br /> • AI{r� Calcli•ett 11,0viv7. M I IS;0y�� �Testse 42929 ' <br /> P t1 <br /> Phone Number ' <br /> (;zeq ) q,�( - 0;�6 9 42930 <br /> Samplers: (Signature) ,(V <br /> d <br /> Projc L� j c�VOL)r5 Mod'j '", '1"x u4t- � , /GeoAudit [� <br /> �' a / - ClierTt EJ1 Sample Location Sample Type No. of / <br /> Number Description Date Time Water Solid Notes <br /> Comp. Grab. Air ContS. <br /> I1.-S-qy 16" 13 X 3 Not 461 11nc54IC <br /> Mw- � / t;Z- ,;-qq 16: (6 z X <br /> -4L) 16 :1C) Z X <br /> 5 P 1 7 5 )cci�l,ic I 5 ,,v 15:0 77-1 <br /> I <br /> 5P I - 5 NE tS.12 <br /> 7 x <br /> 5PC3 W 17. 3c' X SF9-- 7w5r;� -A <br /> )rnqu ss a y: Signature) a er <br /> Y Y grm / <br /> (i (i11 1�. J LC )ldrl C/Uf'Y IA 1�1- Dnte/lime <br /> eli quish�!r (Signature) <br /> ecd by: (Sign re / DattOime <br /> Relinquished by: (Signature) / /Z-7-9 <br /> Received by Mobile laborntory for field anolysis: (Signnture) Date/Time <br /> I � <br /> Dispatched b Si nature t t <br /> y' ( g ) Dnto/1 ime =�, <br /> oratory by: ' 42931 <br /> t <br /> 1 t <br /> i n <br /> Method of Shipment: ::::: Laboratory Name i <br /> v� 42932 <br /> PRESERVATKIPN � Co/tt 'e 1 <br /> Special Instructions: I hereby authorize the performance of the soove rnarcatea work. t <br /> G00C G70! ITION APPROPRIATE <br /> nLtALJ H _ ,til t,�l� r✓l,,f;�l �,1 <br /> 1 1 ] 1 1 l 1 1 1 1 1 l 1 l 1 1 1 1 l <br />
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