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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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��� t� � � i � i� f, ititititi fi 1• Q�� � � � I <br /> Advanced CHAIN OF CUSTODY CORD ' <br /> GeoEnviron mentai, Inc Date ?-� ° Page of <br /> JJ J <br /> 837 Shaw Road- Stockton, California- 95215 - (208)467 1006 Fax (209) 467 1118 <br /> Client ti 4,_ Firect Mana er <br /> Tests Required <br /> �k 1 <br /> 0'- <br /> Pone umber, <br /> a� �'T 1604 <br /> Samplers (Signature) Invoice <br /> Project Name AGE <br /> t� �d ; - - Client E:] <br /> J <br /> Sample Location Sample Type No of <br /> Date Time <br /> Number Description Water Air Solid Cants N Notes <br /> Comp Grab <br /> l 1�K L 2E p�� WS --X - I <br /> 1~7 �Aw <br /> 14 <br /> X <br /> +�4 X 1 ,4- l S` MX1 <br /> e inq(ishe y (Signature) aceive y ignature <br /> Da !Time <br /> 17a� <br /> Relinquished by (Signature Received by (Signature) patefTi e <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) `'"iDala(Time <br /> Dispatchad by (Signature) Dateffime Received for Laboratory by Dale/Tim <br /> CV -o-,k ' <br /> Method of Shipment CJ Laboratory Flame f <br /> rlL J <br /> , <br /> Special Instructions (� I hereby authorize the <br /> performance of the above Indicated work <br /> coo <br />
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