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ARCHIVED REPORTS XR0001660
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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CLAY
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639
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3500 - Local Oversight Program
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PR0544513
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ARCHIVED REPORTS XR0001660
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Entry Properties
Last modified
6/14/2019 1:15:59 PM
Creation date
6/14/2019 10:59:02 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0001660
RECORD_ID
PR0544513
PE
3528
FACILITY_ID
FA0024115
FACILITY_NAME
WEST CLAY PROPERTY
STREET_NUMBER
639
Direction
W
STREET_NAME
CLAY
STREET_TYPE
ST
City
STOCKTON
Zip
95209
APN
14707110
CURRENT_STATUS
02
SITE_LOCATION
639 W CLAY ST
P_LOCATION
01
QC Status
Approved
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EHD - Public
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I <br /> Advanced CHAIN OF CUSTODY ECORD <br /> GeoEnv>ironmental, Inc Date °` Page �, <br /> 837 Shaw Road - Stockton, California- 95215 - (209)467 1006- Fax (209)467 111a <br /> Client VILA, Project <br /> t M na r Tests Required <br /> E4--� i <br /> P one umber <br /> Samplers (Signature) Invoice <br /> Project NameW&,&+ <br /> AGE <br /> cj Ct (-0 Client ❑ <br /> � <br /> Sample Location Date Time Sample Type Solid No of <br /> Number Description Water Air Conts N Nates <br /> Comp Grab <br /> BUJ 2 <br /> Y <br /> )G - <br /> e i qui! ® y Sig tura 'Received y ignature D Ie/T is +y <br /> Relinquished by (Signature) Received by (Signature) <br /> Dal/lame <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) / Date/Time <br /> Drepalthud by (Signature) DatelTtme Roceived for Laboratory by �1 DatelTime <br /> Melhod of Shipreent La oralory Name C' 421�0 <br /> CoL it-N% <br /> Special Instructions ,k1 r/ I hereby authorize the parformance of the above Indicated work II <br /> A)FFb <br /> f <br />
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