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Environmental Health - Public
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EHD Program Facility Records by Street Name
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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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Geological Audit Services , Inc. CHAIN OF CUSTODY RECORDvDate ,7-,-43 Page Z of <br /> Ern�irnnmenta Profess�nals <br /> gob" 1803 West March Lane,Suite A-Stockton,California-95207-(209)958-0284 <br /> ClientProject Manager <br /> L�tjc�ron �5 MgrY�e Vob May+ Tests Required <br /> Ph?,ne Number <br /> coq q96-0;.6t1 <br /> Samplers: (Signature) /Invoice: <br /> Project Name Cq jd r.N's Mdrut 94V(1�11 414,c944�� /'/eoAudft [2q <br /> Client <br /> Sample Location Sample Type No. of <br /> Number Description Date Time Comp. crran <br /> Air Solid Conts./,�4�� �? / i /j Notes <br /> N , Noy? wa�� ��-1-q3 17 b x 1 x x 9.3-/aoa —/6 - <br /> N ' 1 NF-- Corns I �: Sd X Y, <br /> Relinquished by: (Signature) Received by: ignat re <br /> lard j'.}j.T, Date/Time <br /> Relinquished by: (Signature) Received by: (Signature) Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date rime Received for Laboratory by: <br /> Date(rim e <br /> Method of Shipment: Laboratory Name-- <br /> A I <br /> ameAI <br /> Special Instructions: I hereby authorize the performance of the above indicated work. <br />
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