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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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1876
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2900 - Site Mitigation Program
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PR0542421
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Last modified
6/21/2019 12:16:08 PM
Creation date
6/21/2019 10:01:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0542421
PE
2950
FACILITY_ID
FA0024377
FACILITY_NAME
COUNTRY CLUB BLVD/295950
STREET_NUMBER
1876
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12319101
CURRENT_STATUS
01
SITE_LOCATION
1876 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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SJGOV\wng
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EHD - Public
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83 833y 3,0 4. <br /> ROJ.�N+. PROJECT NAME � <br /> L.P.NO. SA PLERS:{sIgnatury <br /> OF <br /> CON- r !} <br /> ` DATE SAMPLE E.D. TAINERS �Y fi- REMARKS <br /> + j f r • T I, t'. I tG (xcS <br /> ,yh <br /> k• <br /> i <br /> 6 <br /> 7, <br /> Reli q is d y: sb ak Date/Time Received by:fsipnatura) Remarks <br /> le°2G Cc-1,4'V +'1µ l3 S�/�rt��� I'll . <br /> R in shad by:fSb .ray Date/Time Received by:(slpnaturo) T. E A v,ak/.,, �o n�;e IL �0✓ t bf I}' J CG!- �_ r h <br /> Relinquished by:tsipnawrot te/Time Received for Laboratory by: <br /> �.SO (Sign turn) <br /> Canonle Environmental,212 Frank West Circle,Suite A,Stockton,CA 95206 <br /> N° 08420 <br />
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