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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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A CHAIN OF CUSTO*RECORD <br /> l Advanced <br /> - %' GeoEnv>ron mental, Inc Date 2 I � ( Page of Z <br /> Y <br /> 4005 North Wilson Way-Stockton,California 95205 (209)467 1006-Fax(209)467 1118 <br /> CllenteqA� s P o ect Mann er <br /> —F- <br /> -1t.1 L �7 ai,r�� <br /> Tests Required <br /> Phone Number / <br /> Samplers (Signature) Invoice <br /> Projeet NameNAA, AGE <br /> �� � � � Client ❑ <br /> Sample Location Sample Type No off <br /> Number Description pate Time Water Solid Notes <br /> C , <br /> ComAir Contsp Grab i I <br /> 5�,� ecu S act[ 'rLL z3- 1 e l�`2 \X X - ��fi�9 j_ <br /> G -SwL (q` l- <br /> 1 � X � � � Ffi_�690 <br /> e y i n ure) Seceived by ignature Date/Time <br /> Relin uished by (Sinature Received by {Signature) ���f�f l�ftf7 r �• <br /> Dale/Ti e <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Dale/Time <br /> I <br /> Dispatched by (Signature) Date/Time [Received for Laboratory b � Date/Time <br /> AVI <br /> J,//Z/ <br /> 7 !� <br /> Method of Shipment Laboratory e~ _ f <br /> Special Instructions I hereb7tnt rize the erform ce of the above indicated work <br /> VIM I------- <br /> • <br /> ICEI+ PRESERVATION <br /> GUODUUNUITION APPROPRIATE <br /> }jrA,D C(]Ar"- nnn"TT rfirIrAI it—, <br />
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