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ARCHIVED REPORTS_XR0003775
Environmental Health - Public
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EHD Program Facility Records by Street Name
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H
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HAZELTON
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375
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2900 - Site Mitigation Program
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PR0540905
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ARCHIVED REPORTS_XR0003775
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Entry Properties
Last modified
2/3/2020 9:41:30 PM
Creation date
2/3/2020 9:13:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003775
RECORD_ID
PR0540905
PE
2960
FACILITY_ID
FA0023406
FACILITY_NAME
SIERRA LUMBER MANUFACTURERS
STREET_NUMBER
375
Direction
W
STREET_NAME
HAZELTON
STREET_TYPE
AVE
City
STOCKTON
Zip
95205
APN
147120808
CURRENT_STATUS
01
SITE_LOCATION
375 W HAZELTON AVE
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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a_ � � t� tt♦ t� t� its t� t� � � � � � � � � r <br /> CHAIN OF CUSTODY FORD <br /> Advanced <br /> GeoEnvironmental, Inc. Date -Z Page <br /> I !a fid <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1118 <br /> ClientProject Manager <br /> 5 i @ r��} R Tests Required <br /> --r <br /> A Cud 16 <br /> Phone Number <br /> 2 q - tI kl -lo <br /> Samplers. (Signature) , Invoice: <br /> j - <br /> Project Name {rpr AGE <br /> � bf Client d <br /> St <br /> Sample Location Sample Type No of <br /> Date Time Water Solid Notes <br /> Number,„ Description Comp crab Air Conts ^r <br /> LAP <br /> "pre., <br /> ., ryj ix 9298 <br /> Mw -55 ftii 4 <br /> x <br /> q \\ s <br /> AT <br /> x x <br /> X � <br /> X 71 <br /> Relinquished y (Signature) Received y (Signature STANo ate(Time <br /> fl RA 3 <br /> Relinquished by gn ure) Received by (Signature) Date rime <br /> t s, <br /> Relinquished by (lagnature) Received by Mobile Laboratory for field analysis (Signature) DaleTTime <br /> Dispatched bye' (Signature) Dale/Time Received for Laboratory by Date/Time <br /> � t <br /> 4 <br /> Method of Shipment t� ON p 3� A a Laboratory Name <br /> F D Cx. 5 eo low e r.,4ac4 y0AS METALS OTHER MGC m I) <br /> Special Instructions 1 hereby authorize the per ormance of the above indicated work <br /> t GOOD CONDITION APPRDPPIATF <br /> flEAV FACE <br /> 3 �r <br /> A <br />
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