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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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FIELD DOCUMENTS
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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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_A. <br /> D c� <br /> Geological Audit Services <br /> S , Inc. CHAIN of <br /> CUSTODY RECORC <br /> 1603 West March Lane•Suite A-Stockton Ca Date <br /> • lifornia-95207- 209 9 1 Page t 2 <br /> ( ) 580264 <br /> Client Nq, L <br /> �d �a Project Manager o27a i 5 <br /> M C K►l Tests Required <br /> Phone Number <br /> (;oq) 796 - 0.A6 <br /> Project Nameq ►^D h'S <br /> ?— Samplers: (Signature) <br /> � l d r1� - Invoice: <br /> Sample GeoAudk <br /> Number Location Sample Type �h <br /> Description Date Time <br /> Water Solid No.of Merit 0 <br /> icomp. Grab. Air Conts. �� Notes <br /> F S�OCt�j 11, 5E at <br /> -J-JL. � <br /> sP) , l :o. ly- X C <br /> 1 <br /> 5 P� `3 Se�urrn ,� 1 Nw to:ZD I 40136 os; -P 5Pjw3•f- <br /> 4CIII (t , 5 1 4 <br /> 5P2, - q r <br /> 5 ' � 1°� 3o I 0137 � a 5i�• <br /> S P ?, t, <br /> S °J'- to: r <br /> �'� y <br /> � t <br /> W • wl" I 64ftfflP 5p3-3 <br /> to, qa X 1 _ _40138 <br /> ignalure I <br /> °p/B�� Y 19 ure <br /> elinquished by::( ignature) ! � _ •�, <br /> Received b �O:TG _A.T Date ma <br /> Relinquished b Y� (Signature) �q <br /> -,q q �i <br /> Y:(Signature) q,? 1 <br /> Received by Mobile Laboratory for field analysis:(Signature) <br /> Dispatched b <br /> Y:(Signature) <br /> Method of Shipment: Date/Time Date/Time <br /> Received for Laboratory by; <br /> Date/Time <br /> SPecial Instructions: Laboratory Name <br /> Mc� <br /> I hereby au <br /> the P thorize arformanoa Of the above Indioataa work. <br /> •N�. t <br />
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