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ARCHIVED REPORTS_XR0004993
Environmental Health - Public
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EHD Program Facility Records by Street Name
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M
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MONTE DIABLO
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2650
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3500 - Local Oversight Program
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PR0545577
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ARCHIVED REPORTS_XR0004993
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Entry Properties
Last modified
9/16/2020 12:23:51 AM
Creation date
3/19/2020 1:49:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004993
RECORD_ID
PR0545577
PE
3528
FACILITY_ID
FA0003836
FACILITY_NAME
LOCAL FOOD MARKET
STREET_NUMBER
2650
STREET_NAME
MONTE DIABLO
STREET_TYPE
AVE
City
STOCKTON
Zip
95203
APN
13311131
CURRENT_STATUS
02
SITE_LOCATION
2650 MONTE DIABLO AVE
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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t Advanced U <br /> 07 CHAIN OF STODY RECORD <br /> GeoEnvironrnental, Inc — Date Page of�—_ <br /> 837 Shaw Road- Stockton California- 95215- (209)467 1006- Fax (209)467-1118 <br /> Client �4 Protect Manager Tests R ulred <br /> OK- <br /> Sone NumberLllyyxz <br /> c,,c0 Z,7—foCD,4 <br /> Samplers (Signature) Invoice <br /> AGE <br /> Protect Name 1-4=� � Client ❑ <br /> 6:J C9 <br /> � , <br /> Sample Location Date Time Sample Type WatSolid No of N Notes <br /> er <br /> Number Description Comp r Air Corns <br /> +14J� 0 22a 1"�w Z 0C) X1 X <br /> tiw�s caw—S so 3 X <br /> Jzpat /Time <br /> nature Received y +gnature <br /> -Relinquished ( g ) <br /> Relinquished by (Signature) Received by (Signature) pataff e <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Recet r Labora ry b La[Trme <br /> A b <br /> Method of Shipment n Laboratory Name Cc, <br /> 4ec-[,„L, <br /> Special Instructionst I hereby authorize the performance of the above Indicated work <br /> Ne2 � ��� <br />
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