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ARCHIVED REPORTS XR0004675
Environmental Health - Public
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EHD Program Facility Records by Street Name
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M
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MADISON
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423
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3500 - Local Oversight Program
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PR0544427
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ARCHIVED REPORTS XR0004675
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Entry Properties
Last modified
5/7/2019 9:21:21 AM
Creation date
5/7/2019 8:35:30 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004675
RECORD_ID
PR0544427
PE
3528
FACILITY_ID
FA0004581
FACILITY_NAME
CHASE CHEVROLET*
STREET_NUMBER
423
Direction
N
STREET_NAME
MADISON
STREET_TYPE
ST
City
STOCKTON
Zip
95203
CURRENT_STATUS
02
SITE_LOCATION
423 N MADISON ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\wng
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EHD - Public
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I <br /> Advanced CHAIN OF CUSTOigRECORD <br /> 4L_ <br /> GeoEnvironmental, Inc. Date Page of <br /> C-__-rA04 3 3 <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467-1116 <br /> K•M, <br /> Client GProject Manager <br /> S C �C S f �C V+ pc��h�C 4 Tests Required <br /> Phone Number <br /> Samplers (Signatur ) Invoice- <br /> AGE4--, <br /> Project Name f av i d o} Client p <br /> Sample Location Date Time <br /> Sample Type <br /> Solid No of Notes <br /> Water ' �", t. k # __, <br /> Number Description Comp Grab Alr Conts y r t1,icy , ,�� �, <br /> 3 �f <br /> �N <br /> "- <br /> OB `50 <br /> 1 02779 4 ,,- <br /> .� W_Z1 Z_;_ <br /> e rnqu e ySignature) ecewe y Isignature �l>e+a••�' Dateru e <br /> SCI <br /> � r i S�4G <br /> Relinquished by (Signature) Received by (Signature) � n <br /> Date me <br /> ? � �7��G-• NpITEdN_1� ArP�}PARrG�hk+MATE �•-3.q� �g :4 � <br /> Relinquished by (Signature) Received by Mobile LaboratorRW'SVAtaP8ff9n CONTAIIVERS� DalelTlme <br /> Dispatched by (Signature) Dale/Time e voClor Laborator b( VAf� it /1& �0 �[,art Date/Time <br /> /LaJ/ N <br /> Method of Shipment Laboratory Name <br /> � OVr S � hd 44 <br /> Special Instructions + rr ., i hereby authorize the perform rice of the above indicated work <br /> *�0014LiGtJ t�1�lGt- a �" /_ - <br /> AAK <br /> 1 <br />
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