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ARCHIVED REPORTS_XR0008851
Environmental Health - Public
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EHD Program Facility Records by Street Name
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V
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VAN BUREN
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424
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3500 - Local Oversight Program
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PR0545786
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ARCHIVED REPORTS_XR0008851
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Entry Properties
Last modified
6/1/2020 2:35:39 PM
Creation date
6/1/2020 2:01:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008851
RECORD_ID
PR0545786
PE
3526
FACILITY_ID
FA0004969
FACILITY_NAME
CHASE CHEVROLET
STREET_NUMBER
424
Direction
N
STREET_NAME
VAN BUREN
STREET_TYPE
ST
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
424 N VAN BUREN ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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LSauers
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EHD - Public
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O <br /> Advanced CHAIN OF CUSTOD4CORD <br /> GeoEnvironmental, Inc. Date 7,-y -1 Page ---L <br /> of_,� <br /> � I <br /> of Northern Ca[rfonua <br /> 1803 Wesl March Lane,Suile A Slocklon, California-95207-(209)956-0264-Fax(209)956-0700 '6 Q A aag <br /> ClientII Project Manager <br /> K e V 1 M c K►b i t h Tests Required <br /> Phone Number {G <br /> (meq) q5_6 -d ') 6 -� <br /> Samplers (Signature) Invoice <br /> Project Name G Li AGE <br /> Q 5 � �� �V r,j �`j' — �/Q H �U N�� �� Client ❑ <br /> �h <br /> Sample Location Sample Type No of <br /> Date Time Water Solid t Notes <br /> Number Description Comp Grab Air Conts �� <br /> rl M w-3 -1 --q 7 �'S-4 �s: 3 X �{ X X900 <br /> s .g 7 nd <br /> , <br /> FN Nw-I0 -y'7 IS ((1 X 3 t`, v=.6 ''i <br /> T �F'` <br /> I'1 MAp <br /> Inr-1 /1 `5�-q 7 J �(' `{ 3 ' °, ro�;7350'4 �F <br /> j.) M VV -15h. !~ 17 <br /> :;;;r�h ( rgnalur i y rgna F a�G_Gj� Date/Time <br /> a 5�a�r�d�d T-�•T, <br /> LI :30 -� 7 <br /> Relinquished by (Signature) ived by (SignalVIP <br /> 73505s , <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> 1?4+SrJ�J"'I � rAC <br /> Dispatched by (Signature) nate/Time Laboratory byr", �` ` <br /> A r 1 <br /> Method of Shipment r Laboratory Name <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br /> [CU . <br /> vu v <br /> P I ,cP'�rF ABSENT2 , CONTAINEPS_-f411111-- <br />
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