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ARCHIVED REPORTS_XR0004942
Environmental Health - Public
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EHD Program Facility Records by Street Name
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M
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MOSSDALE
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444
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3500 - Local Oversight Program
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PR0545585
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ARCHIVED REPORTS_XR0004942
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Entry Properties
Last modified
9/15/2020 11:14:15 PM
Creation date
3/19/2020 3:03:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004942
RECORD_ID
PR0545585
PE
3528
FACILITY_ID
FA0000212
FACILITY_NAME
Mossdale Chevron
STREET_NUMBER
444
Direction
W
STREET_NAME
MOSSDALE
STREET_TYPE
RD
City
LATHROP
Zip
95330
CURRENT_STATUS
02
SITE_LOCATION
444 W MOSSDALE RD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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01"R 2- <br /> Advanced CHAIN OF CUSTODSECORD <br /> GeoEnvironmental, Inc. Date Page of_4 <br /> 837 Shaw Road-Stockton, California-95215-(249)467-1006- Fax (209)467-1118 <br /> Client1 Pr rfa r Tens Required <br /> t. <br /> I Pne Number <br /> two <br /> a7rs nature) I voice <br /> Protect Name � � � AGE <br /> f Ctlertit ❑ <br /> Sample Location Sample Type Date of <br /> Number Description Date Time Water Aur Solid 14iConts Notes <br /> Comp Grab <br /> MIA) I� �6 <br /> f/ <br /> r t ff �' <br /> /2 A <br /> a inqui e n re Received by (Signature) 0 err me <br /> f <br /> Reimqurs ed by (Signatur Received by (Signature) at MrT e <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (8ignalure) Date(Time <br /> Dispatched by (Signature) Date/Time Received Tor Laboratory by Da [Time <br /> Method o1 Shipment Laborato <br /> t <br /> Special Instruchor►s I hereby u orize erformance of the above indicated work <br />
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