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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0506390
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FIELD DOCUMENTS
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Last modified
5/6/2019 1:33:42 PM
Creation date
5/6/2019 1:22:07 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0506390
PE
2950
FACILITY_ID
FA0007389
FACILITY_NAME
MINI STOP
STREET_NUMBER
244
Direction
W
STREET_NAME
HARDING
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
13708014
CURRENT_STATUS
01
SITE_LOCATION
244 W HARDING WAY
P_LOCATION
01
QC Status
Approved
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EHD - Public
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l Advanced CHAIN OFC S_ TODY RECORD <br /> GeoEnv.ironi!nental, Inc:" Date Page . ol< <br /> 4005'North Wilson Way-Stockton,California-+95205-(209)467-1006-Fax(209)467-1119 <br />-;, a:' <br /> Client ,� �/+ - / Project Manager , <br /> SJR h.. �, i2�t / Tests Required <br /> /7't- ;;,: Phone Number, <br /> i° Samplers: {Signature} [� 'Invoice: <br /> �ProjEct Name + 1:. AGE. [� <br /> lGG� Client ❑ <br /> w k Sample,TYPe <br /> Sample' Location 'Date. Time Water' Solid No. of Notes <br /> Number Description comp. crab. Air Conts.' <br />.A <br /> 4 <br /> i <br /> .-ri.._...n__:__ue^._iix�.ame f.,[Fn..ut���'_;�,-s - 'f_tie'ays�:fmVa�l::._s_'wia.^ u�_..__A VIM1,...�_—,-�,.-aN•x �—�. J= -=_ 'K .b[' wu.+i'1e4- W'- - ';rtti _ <br /> «rw -r: •-, y.^�,.<^,o„- ..; a.:•---'•�--.,s -,rxr, -r--aq g -ix- r+ 4•ir r+' - �'..,a=: :,_, - '— -wa. - :: - a '. p,-_ti ..'_.,....q- :-:� <br /> gyp= <br /> e:�qu s e y:� I n t eceive by:.(Signature) xd€ �� . Da a ime,' <br /> FN Ofshed by: Ig aturo) Received by: (Signature) ! A ' { 'Y' �' Dale(Tlme <br /> `• <br /> "Relinquished b Si nature bate(Time <br /> y� (Signature)) � Received by Mobile Laboratory for field analysis..(Signature) L-- <br /> Dispatched <br /> Dispatched by': (Signature) " `` r Date/Time Received tor.Laboratory by: Dale/Time ' <br /> Method of Shipment: Laborato Name- . <br /> " Special Instructions: I hereby authorize the performance of the above'lndicated:work. <br /> I <br /> L'��,�,.�.x-J.....,.t.:.-�...,=4:,.i '.___ _... ..� __ .' _., .���--'----_�_._ .. - .:�.4.. I ,_,.�..S.i,..:a,.�..- -J.�'i <br /> �..-. !cam -t° ..s.. <br />
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