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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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Tags
EHD - Public
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r� � rr rr r rr rr rr rr rr r rr �r rr rr r�,r� ■r <br /> s <br /> Advanced CHAIN OF CUSTODY RECORD J <br /> = GeoEnvironmentai, Inc. nates Page 3 of 3 <br /> -" of Northam Califorma <br /> 1803 West March Lane Suite A Stockton California-95207 (209)956-0264-Fax(209)9560700 1133 X t � <br /> Client H arTv,Za h .r 5 7- Project Manager <br /> Fab Mare Tests Required <br /> Phone Number <br /> (2o Q) q 6`_6-oZ 6 W <br /> Samplers (Signature) �� Invoice <br /> h{ Protect Name [_Lt a 5 -t � <br /> L 11 ttr r0 k1- — I"lQ G 501"l � '`"�` �` '1 h° �- AGE [� <br /> 116- Client <br /> Sample Location Sample Type X rY �, <br /> rY Number Description date Time `Y <br /> { Comp Water <br /> Air Solid Contsf L,�,�� �� �� 00 i Notes <br /> > r <br /> (2P7 -)-O 7-'a tjj� 'J tVor6-t6-q5 X 2 7C X X X X �( 1 53514 1 <br /> U P 7 -zti ►t i b-os X z X X535 g 5 <br /> i <br /> f (� P19 -zS 50 71% (5-- X 2 X X X K �( 53516 <br /> (, P 3 -)-o -rdKA50til K X , If p L- b 53517 <br /> W-5T ! pT 53518 ; <br /> 3r51t, <br /> t <br /> t � <br /> Relinquished by (Signature) ecy 9 i nat <br /> fj :ZG•�l5 �QLL Yt palelTlme <br /> r 1 <br /> Resin wished b /D .ti G`lq'q f co V <br /> q y (signature) ac ed by (Signa re) <br /> Dale/Time <br /> Relinquished by (Signature) <br /> Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Despatched by (Signature) Date/Time Received for Laboratory by Dale/Time <br /> i <br /> Method of Shipment FLaboratory Name <br /> r Special Instructions <br /> I hereby authorize the performance of the above Indicated work <br /> i�E� rr 9 <br />
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