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ARCHIVED REPORTS_XR0008310
Environmental Health - Public
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EHD Program Facility Records by Street Name
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S
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SCHOOL
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107
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3500 - Local Oversight Program
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PR0545674
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ARCHIVED REPORTS_XR0008310
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Entry Properties
Last modified
5/20/2020 10:13:56 AM
Creation date
5/20/2020 10:00:56 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008310
RECORD_ID
PR0545674
PE
3528
FACILITY_ID
FA0006039
FACILITY_NAME
MARK NEWFIELD
STREET_NUMBER
107
Direction
N
STREET_NAME
SCHOOL
STREET_TYPE
ST
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
107 N SCHOOL ST
P_DISTRICT
004
QC Status
Approved
Scanner
LSauers
Tags
EHD - Public
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www �� �� �� �� � � � � � � etta>• fi ert� a� <br /> i • i <br /> { Advanced CHAIN OF CUSTODY RECORD <br /> _-- GeoEnvironmental, Inc. Dace 09/0'b Page --/ of / <br /> 4005 North Wilson Way-Stockton,California-95205-(209)4671406-Fax(209)4 -1118 <br /> Client ] Project Itanager <br /> Tests Required <br /> IN <br /> Phone Number <br /> 7W <br /> Samplers (Signature) Invoice <br /> Project Name �� � � AGP � I <br /> f Client <br /> Sample Location Sample Type <br /> Number Description <br /> Date Time Water Solid No of Notes <br /> Comp Grab Air Conts i <br /> /Pte �'Z !15 a 40778 <br /> 4779 <br /> I <br /> i <br /> I ( 5..} <br /> ay- <br /> —J— ,..... _ <br /> FLl.i.l ut L I r5thl 11 4T11 <br /> it u's' <br /> Relinquished y (Signature) Received y ( rgnature Date/Time <br /> Relinquished by (Signa ure) <br /> Received by (Signature) Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Ttme <br /> Dispatched by (Signature) Date/Time Re v for Labors cry by <br /> ,�,t I, ( DataJTlme <br /> Method of Shipment [ f1 Y1 L gyratory Name <br /> 1"t � t V C <br /> (Special Instructions I hereby P authorize the erf mance of the above indicated work <br /> A61 <br /> ( '1� <br />
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