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ARCHIVED REPORTS XR0004688
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 XR0004688
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Entry Properties
Last modified
5/7/2019 9:21:32 AM
Creation date
5/7/2019 8:50:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004688
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
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EHD - Public
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( Advanced CHAIN OF CUSTODY RECOR <br /> - GeoEnvironmental, Inc "��" <br /> Date �"'�� v0 Page <br /> Of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467 1006-Fax(209)467-1118 <br /> Client Project Manager <br /> K e v f ti M `-K;b t h Tests Requ€red <br /> Phone Number <br /> )-01 '46 T- tDOC <br /> Samplers (Signature) "� f <br /> �� I ��` �o° Invoice <br /> Project Name [Cray +t C�►rvrcj� � �1ad1'goil �wv�tr�'1 � � AGE <br /> LN <br /> }�W Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Solid No °f Notes <br /> Comp Grab Air COntS �Q <br /> 2-5-0& )3 , �-J5— 30801 <br /> + }' y. i l : ) o y- 30802 <br /> Mw - 11 A -uv 11,4 �— Y X 30803 <br /> 13 . 1 S X X 30804 <br /> 13 - �� y— �( 30805 <br /> Iww -fid 8 -6•ov 1w , a � S� X 30806 <br /> - '3 -00 '-to Xi—EALA 30807 <br /> e[inquis e y rgnatute ec ve y ig alure <br /> �v`[►M, Date/Time <br /> Retrnquished by (Signature) 5014 t 1 vcl r� �_ .0o f !30 <br /> Reserved by (Signature) ! J <br /> DatelTime <br /> Relinquished by (signature) Received by Mobile Laboratory for field analysis (Signature) <br /> DatelTlme <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by <br /> Dale/Time <br /> Method of Shipment III <br /> CA a v�r k f k T Icule G Laboratory Name <br /> 1 L PAPS P A M`Cawr 0,k tl <br /> Special Instructions �llr](+(}LfD�rl��l <br /> UD tit N li N APPROPRIATE 1 hereby authorize the performance of the above Indicated work <br /> CONDINE <br /> '! r <br />
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