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ARCHIVED REPORTS XR0004805
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 XR0004805
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Entry Properties
Last modified
5/7/2019 9:22:08 AM
Creation date
5/7/2019 9:14:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004805
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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' r r r r r r r r r rr r r r r r r Ir rr <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date ��-� Page of <br /> of Nonhem CuJrfr�ntur <br /> 1803 West March Lane Suite A Stockton California-95207 (209)956-0264-Fax(209)956-0700 �'v g— <br /> Client <br /> gClient ��7 m yl S eTn Q s5 Protect Manager <br /> K t g m G K r bb,th Tests Required <br /> Phone Number <br /> ' <br /> Samplers (Signature) `,� 1 Invoice <br /> Protect Name �a5 C Qvrpl ISD� t <br /> Client <br /> EJ- <br /> Sample Location Date Time Sample Type Solid No of a eNotes <br /> Number Description Air Conts , <br /> Comp Grab '� �1 i <br /> l <br /> 57236 <br /> ehnquis e y (Signature) Bec ignature DatelTime <br /> Rehr uished by (Signature) neceived by (signalur)7 DatelTime <br /> 'mac 1 Zc)s <br /> Relinquished by Signatur ivPd by Mobile Laboratory for field annlysrs (Signature) DaEeliime <br /> Dispatched by (Signature) Dale/Time 11ecowed for Laboratory by _ Datelfimp <br /> Method of Shipment Laboratory Name <br /> Special instructions � + I hereby authorize the performance of the above indicated work <br /> ` <br /> _ r ✓,._1. .,._i <br /> iSLNI C <br />
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