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ARCHIVED REPORTS XR0004679
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 XR0004679
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Entry Properties
Last modified
5/7/2019 9:18:31 AM
Creation date
5/7/2019 8:37:22 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004679
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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(� Advanced CHAIN OF CUSTODY CORD <br /> == GeoEnvtlronmental, Inc <br /> Date j }'S Page 3 Of <br /> 4005 North Wilson Way Stockton,California 95205 (209)467 1006 Fax(209)467 1119 <br /> Project Manager Tests Re uired <br /> Client Navymavt ►� fS-c��4sf 14kov, WKibl� q <br /> Phone Number <br /> (90q ) X167- I00 <br /> Samplers {Signature) Invoice <br /> �j(,, ,�� [�J <br /> Project Name C_Iia s-t C � zv ro I P-T - Mad i50� /u`'�`'`�t� AGE <br /> p <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts <br /> Comp Grabr- <br /> 3 <br /> r <br /> V[ <br /> }ter-. '.- <br /> rSSJ <br /> P 37 40 ►S. D <br /> �3 tt�I ��117YU+J,Crpr[r'; t <br /> G P3 7- 45 0 <br /> Dalef rime <br /> e Inqurs ed by �(�rr�atc� _ure -� Received y Ignat re � 11�tj CV IT <br /> elinqurshed by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> H `ca►h b�l J <br /> Special Instructions W J'"Iihnd I hereby authorize the performance of the above Indicated work <br /> till <br /> r <br /> FII_AU SPIKE N-L"S'r I!I_0 <br />
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