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ARCHIVED REPORTS_XR0004956
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_XR0004956
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Entry Properties
Last modified
9/16/2020 2:05:33 AM
Creation date
3/19/2020 3:30:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004956
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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j Advanced CHAIN OF COSTO RECORD <br /> GeoEnvlronmental Inc. Dare Page '�of <br /> 4005 North Wilson Way Stockton,California-95205 (209)467-1006 ax(209)467-1118 <br /> Client Project Manager <br /> Tests Required <br /> Phone Number <br /> l <br /> Sam lers (Signature) Invofc <br /> ' AGP <br /> Cbertt ❑ <br /> Project Name <br /> Sample Type <br /> Sample Location Date Time Solid No of Notes <br /> Number Description comWateGrab Air Conts <br /> - p 24723 <br /> tz a 24724 <br /> ly <br /> I r ' <br /> 1 12 , <br /> 24725 <br /> k r <br /> 24726 <br /> 24727 x t <br /> ;r <br /> 24728 <br /> 47 <br /> e inq s e gnalure Received by (Signature) DetelTtme <br /> gbAA11 <br /> Relinquished by 1Sig ure) Vll� ��rure) Datell ime <br /> ` ; R <br /> Refinqurlt (S tura) f '' R "ived by Mobile Laboratory for field analysis (Signature) DatelTimo <br /> t iU�1�E <br /> Dispatch T7Cl�Uj +{� iveior LaDelelTima ti i Date/Time <br /> &ACy + orato <br /> 2l� <br /> Method of Shipment Laboratoty me �. <br /> J <br /> Special Instructions (, I hereby authorize the performance of the above Indicated work <br /> fid �iV �,(� 44� � .tl✓ i <br />
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