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ARCHIVED REPORTS XR0004689
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 XR0004689
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Entry Properties
Last modified
5/7/2019 9:21:00 AM
Creation date
5/7/2019 8:50:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004689
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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CHAIN OF CUSTOORECORD <br /> Advanced <br /> - GeoEnvzxonmental, Inic Date Page —� of <br /> ./ 4005 North W lson Way Stockton Caiitorriia 35205-(209)467 1006 Fax(209)467 1118 <br /> Client ,Project Manager <br /> KTests Required <br /> Phone Number <br /> 00 <br /> �o c <br /> Sat�pte tSig ure) �` mar Invoice <br /> / �'� AG <br /> Project Name L h�5 C7 e ti [ : T -" ctc� S Client ❑ <br /> L � <br /> � ! Sample Type <br /> Sample Location No of <br /> Number Descr 1pt-cn Date i T,,--,,e comgdateGra� Air Salfci Cants `� <br /> 25482 <br /> 25483 ! <br /> xi 26454rJt V1 r <br /> l , 25455 <br /> 25466 <br /> _ 25467 L <br /> 11VV,C �{ <br /> f4/ l�,q- ' l , t y' h � a( 25488 <br /> r r <br /> Rcli q <br /> db (Sign-zfur Rocmved byigna re (] t <br /> atolTtme <br /> 5furtC}cict �'- � �� <br /> lt/ G�S <br /> Fieftngthed by (Scgnatu c) Rfl ed by (S gn ure) DateMme <br /> Pelinq,iished ,iy (S3gn-f.rcl I deceived by Mobile Labor atony for'ield analysis (Signature) DatofTime <br /> I <br /> Dispatched by (Signa,u e) Date/Time Recccved'o. Labo atory by Date]Time <br /> Method of Shipment - Laboratory Name <br /> ,j <br /> Special I�struc ns V0A, 1DRI ETh[S OTHER i I hereby authorize the performance of the above indicated work <br /> IMP A <br /> GL90D CCl'�fDIT1G�`J__ FtsI�Tc <br /> ILI1J <br />
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