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ARCHIVED REPORTS XR0004699
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 XR0004699
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Entry Properties
Last modified
5/7/2019 9:24:23 AM
Creation date
5/7/2019 9:09:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004699
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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Advanced <br /> CHAIN F CUSTODIRECORD <br /> W-- GeoEnvixonmental, Inc <br /> Date �1 Pape -2— of <br /> 837 Shaw Road- Stockton, California- 95215- (209) 467-1006- Fax (209) 467-1118 <br /> ClientP eat M na r <br /> KI 4-1 <br /> Tests Required <br /> F Phone <br /> umber <br /> Sam (SIstore) Invoice <br /> Project Name a AGE ❑ <br /> 0— A CUS1e_ MOz—c155 / �C ry Client ❑ <br /> Sample Location Sample Type No of <br /> Date TimeWater _ S011d <br /> Number Description Air Cants <br /> Camp (arab <br /> 83608 <br /> 11136 <br /> 83609 <br /> 83610 <br /> e tnq se YS-_n alo acarus y Bnature R lalTimt► <br /> V �75 <br /> Relrnq tshe y (Signature) Received by (Signature) nate/Time <br /> e inqu shed by ( ignature) Received by Mobile Laboratory for field analysis (Signature) , DalefUrne <br /> Dispatched by (Signature) DatalTime Recety d r laboratory�i D lair{tris <br /> Method of Shipment Labor or Name <br /> Ae�zl <br /> Special Instructions V AS �JA1S OT�.�M 1 hereby eut Ize file p formanca of the above Indicated work <br /> J VICl11�LJ 11i^�f_ff <br /> {(1 ilI�fTlr3��� R(3PRIA� ` <br /> r , f4 - <br />
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