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ARCHIVED REPORTS XR0004684
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 XR0004684
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Entry Properties
Last modified
5/7/2019 9:21:26 AM
Creation date
5/7/2019 8:40:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004684
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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EHD - Public
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� Advanced <br /> • CHAIN OF CUSTODRECORD <br /> GeoEnvironmental, IncI� fJ c <br /> bate Page of� <br /> 4005 North Wilson Way-Stockton California 95205-(209)487-1006-Fax(209)467 11 <br /> Client Prod Mana er <br /> Tests Required <br /> P ne umber <br /> ') -'Ilo 7LIM Saar S (Sign e) n Invoice <br /> Project Name +� AGE <br /> ����� Client ❑ <br /> Sample Location Date Time Sample Type Solid No of Nates <br /> Number Description Wrier Air Conts <br /> comp I (arab <br /> -61114 --- <br /> 4 b r'-0r-1�lj -' <br /> it , 1) 4 <br /> .. <br /> Yet �� 61116 <br /> 413 <br /> 61117 <br /> -- <br /> /'tAJ,-1 <br /> 4� <br /> -n rI Jt 'l�l� _ 61120 <br /> 91 <br /> e inq a ignature eceive y (Signature) Datef it <br /> !?!r/ <br /> Relin cashed by (Signature} Received by (Signature) ^ ` ata[Time <br /> / f 17 mG I <br /> R/ <br /> Relinquished by (Signature) Date/Time <br /> GOOD��N _gg� v by Nia t P. <br /> � ) <br /> it m '�:Sr7A <br /> Dispatched by (Signature) DabUMAINIERY_ Received or Laboratory by ! Date/Time <br /> tt. {L- 11'G <br /> Method of Shipment . Labora cry Nam <br /> 4k <br /> Specrai Instructions i I her h. 1z the ormance of the above Indicated work <br />
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