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ARCHIVED REPORTS XR0004744
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 XR0004744
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Entry Properties
Last modified
5/7/2019 9:30:22 AM
Creation date
5/7/2019 9:09:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004744
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 CHAIN OF CUSTODY RECORD ` <br /> = _ GeoEnvironmental Inc. 6-�"q-'1 r <br /> --- � Date 5 Page [ of <br /> of Norihent Calrfonua <br /> 1803 West March Lane,Suite A Stockton California-95207-(209)9560254-t=ax(209)956-0700 33 &EX <br /> Client H d y r,,,t Q yt # 5 RTS S S Project Manager <br /> f <br /> Vo b Tests Required <br /> r` Phone Number <br /> ("q ) gs6 °)- 6L) <br /> Samplers (Signature) Invoice <br /> Project Name C-IgAyro i tT — rJqdi5o V1 2�-(Nyl,n4'ttc 911A, AGE <br /> Sample Location Sample Type No of <br /> Client ❑ <br /> Number Description Date Time Notes _ <br /> Water Solid <br /> Comp Grab Air ContS <br /> `J <br /> bpIS Tata 4 4 L�r1��ir 6- IS-qa q=[0 ,' X3500 <br /> X X r <br /> UP -�,v t 53501 <br /> 6 P [ _yy t` a qa 53UJ 2 <br /> ti <br /> GPz- �`'�� East 10:00 l X r 53533 <br /> E GP2-- --o <br /> E GPz ��y <br /> r' 11 , 00 <br /> 50o t, <br /> t <br /> e rnquis e y Xe y (Si gnature J r <br /> Date Trma <br /> 1,7 <br /> Relinquished by (Srgnatme) ceived by {Signature} <br /> t' Date/Time <br /> Relinquished by (Signalure) Received by Mobile Laboratory for held analysis (Signature} <br /> Date/Time <br /> I <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by <br /> l Date/Time <br /> Method o! Shipment r Laboratory Na <br /> me <br /> r` e�z �-a <br /> K <br /> Special Instructions -«- I hereby authorize the performance of the above Indicated work <br /> .a L i 11110,iI <br /> roor <br /> fr,��r•%p%rr��= co�rrtm�s <br />
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