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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0543577
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Last modified
12/19/2019 11:09:39 AM
Creation date
12/19/2019 11:02:24 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0543577
PE
2952
FACILITY_ID
FA0003965
FACILITY_NAME
PG&E
STREET_NUMBER
4040
STREET_NAME
WEST
STREET_TYPE
LN
City
STOCKTON
Zip
95204
APN
11702001
CURRENT_STATUS
02
SITE_LOCATION
4040 WEST LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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The Twining Laboratories, Inc. <br /> CHAIN OF CUSTODY RECORD <br /> Project No. ZZ- 6E6 -60 2 --Dd G- f'& S'TC7CTCJ�ej <br /> Date/Time Sampled _/- a - 8 G <br /> Affiliation of Sampier/Shipper 5W-ic- <br /> Address Z 7 --L-0 s' �. �.-� G4 9 11,0 -70-7- I <br /> Number Street City State Zip Telephone <br /> Collector's Name <br /> Signature <br /> Transported By x'`+»C Date Shipped 7— O L <br /> Sample Receiver 7-1- <br /> Address <br /> Date/Time Received /•- �� a <br /> Comments <br /> Collector's <br /> Sample No: Sample Description Analysis Requested <br /> J-41%Vy�,e./ a'J 7'u.+.� T+i�7-/ r°G�S� a, ! r. .j rL�s C_. <br /> Z �/Tyry4T _A-z� t&^-y !4-f� Z f �TX� C �cr•/7�a So �r � <br /> Chainof�ssion: <br /> 45 <br /> Signature Affiliat" Inclusive Dates <br /> 2. TIE? y <br /> klvj-"Al - — — 1-1� -31 <br /> Signature Affiliation Inclusive Dates <br /> s. � /-9-4-7 <br /> Signature Affiliation Inclusive Dates <br /> 4. <br /> Signature Affiliation Inclusive Dates <br />
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