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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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is <br /> ( Advanced CHAIN OF CUSTODNWCORD <br /> Date Page of <br /> GeoEnvironmental, Inc. :;2 t4 <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467 1118 <br /> Client — T ProMa ger <br /> 4& D6450-90.-D6450-90.- Tests Required <br /> ] " <br /> p on Number <br /> av) <br /> (Signature) Invoice <br /> AGE <br /> Project Name Client ❑ <br /> Cti1 � <br /> Sample Type <br /> Sample Location pate Time Water Solid Na of Notes <br /> Number Description Air Conts <br /> Comp Grab 61121 <br /> �a-&- I e3 <br /> � I � fi1122 <br /> I <br /> 61123 <br /> e inquiel <br /> e y +gnatuf ) eceive y (Signature) Date/Time <br /> vaAs o&c I �TALs oN <br /> Relinquished by (Signature) ��`�{ eceived by`(Sign Date/Time <br /> GOODCO 1T104 � APPROPRIATE � <br /> Relinquished by (Signature) HEAD SPP � � ¢ i eld analysis (Signature) Date/Time <br /> Dispatched by (Signature) LC Date/Time lRecelvedifor Laboratory by J Date/Time <br /> Method of Shipment Laboratory Na a <br /> Special instructions I hereby author e t e pert ance of the above indicated work <br />
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