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ARCHIVED REPORTS_XR0005021
Environmental Health - Public
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EHD Program Facility Records by Street Name
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M
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MOFFAT
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983
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2900 - Site Mitigation Program
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PR0507952
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ARCHIVED REPORTS_XR0005021
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Entry Properties
Last modified
9/16/2020 1:15:01 AM
Creation date
3/17/2020 2:01:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005021
RECORD_ID
PR0507952
PE
2950
FACILITY_ID
FA0007846
FACILITY_NAME
OLYMPIAN CFN
STREET_NUMBER
983
STREET_NAME
MOFFAT
STREET_TYPE
BLVD
City
MANTECA
Zip
95336
APN
22115006
CURRENT_STATUS
01
SITE_LOCATION
983 MOFFAT BLVD
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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rr rr rr r r r� ri rr lr � r rr rr r� rr rr rr rr rr <br /> (�L Advanced CHAIN OFCUSTOD ECORZD <br /> -_ GeoEnvironmental Inc Date Page of <br /> 4005 North Wilson Way Stockton California 95205-(209)467 1006 Fax(209)467 1118 <br /> Client NV- Project Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> AGE 2/ <br /> Project NameCIC Client ❑ <br /> w / <br /> Sample Location Date Time Sample Type Solid No of <br /> Water ��Q` Nates <br /> Number Description Comp Grab Air Cants <br /> S I -oz 23z, ✓ l zy Ddu.- <br /> 6X 5:P Z -D3 3�5 I <br /> DAX ? r6+ 12gc 1 \ - <br /> -F11JU311Y -05 2"' 4o <br /> 7'10 z 0 - 0� -Z O ' <br /> Tti q 19 ' —10* i2 `5 <br /> e m u by (Signature ivey gnature) Date/TiMe <br /> , C,L., C , N7 -rte <br /> ehnq y ( rgna ure) Received by (Sig a ure),' Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Trme <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> Method of Shipment Laboratory Name <br /> Special Instructions 1 hereby t ze the petiormance of the above tndtcated work <br />
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