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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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EHD - Public
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a <br /> [ Advanced CHAIN OF CUSTOD ECORD <br /> --- GeoEnvironmental, Inc. ��€ �; Date 1-�' Page _ of 'I- <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1119 <br /> Client PEQLect Manager <br /> Tests Required <br /> ZoneNumber <br /> )A� —Is <br /> Samplers (Signature) Invoice- <br /> Project Name AGE <br /> Client ❑ <br /> Sample Location Sample ype <br /> Number Description <br /> Date Time Water Air Solid Coats# Notes <br /> {{ �j�'��yy�� Gamp Grab <br /> t' l �T VV <br /> X <br /> 54610 <br /> 54611 - <br /> I <br /> rn u s gnature) ece ve y gnature Date/Time <br /> 1112-81.0 T go <br /> ed y (Sig atura) Received by (Signature) Date(Time <br /> I <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Time <br /> C <br /> Dispatched by (Signature) DatelTime Re Mor Laboralo y amme <br /> r11 /Dat /� a <br />` Me adof Shipment s Lab story came <br /> Special Instructions I hereby aut rlxe the performance of the above Indicated work <br />
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