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ARCHIVED REPORTS XR0004685
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 XR0004685
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Entry Properties
Last modified
5/7/2019 9:18:16 AM
Creation date
5/7/2019 8:41:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004685
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
Tags
EHD - Public
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� Advanced <br /> CHAIN OF CUSTODY RECORD <br /> =_ ate Ila- p Page of z <br /> GeoEnv>ronmental, Inc.enc <br /> �.���X31 <br /> 4005 North Wilson Way-Stockton California-95205-(209)467-1006-Fax(209)467-1118 <br /> Clienth F- d Pro act Masa er Tests Required <br /> Phone Number <br /> 2 4;-7 ?� <br /> Samplers, (Signature) Invoice <br /> AGE <br /> Project Name � � �/�,r -IDE3�WA Client ❑ <br /> Sample Location Solid Sample Type No of <br /> Number Description Date Time Water Air Conts Notes <br /> Comp I Grab <br /> ''kms#( �i' �c 54602 <br /> X 54603 <br /> 0 �� �� � � � 54fiO4 <br /> ��= L k <br /> � � - �� �� 1� b k x 54605 <br /> 11�154606 <br /> 54607 <br /> 30 <br /> 54608 <br /> ern gn lure ecerve y rgrtalure DatelTime <br /> On `fir ca <br /> RtrKqVsffe—d't-y (Signature) Received by (Signature) DatetTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/time Receive or Laboratory Date rime <br /> Mqlhod of Shipment Labor ory Name <br /> Special Instructions 1VAJIIJN I hereby auth rize the performance of the above indicated work <br /> GOODCONDITION- JMQ,fjJATE <br /> HLAD SFACE ABSENT--W C(NTR1NiiS� <br /> i <br />
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