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ARCHIVED REPORTS_XR0008897
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_XR0008897
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Entry Properties
Last modified
6/1/2020 2:32:03 PM
Creation date
6/1/2020 2:15:21 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008897
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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� � � � � � � � � � � � tffffffffl■ � .e.. <br /> t Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date a Page of Z <br /> 837 Shaw Road-Stockton, California- 95215- (209)467-1006- Fax(209)467-1118 <br /> Client ArKZXV r Project Manager �o Tests Required <br /> Phone Number <br /> 202 6 l <br /> Sam p rs (Signature) Invoice <br /> AGE 0_ <br /> Project Name �,//rg v!M1 da&f k/ Client ❑ <br /> Sample Location Sample Type No. of ' <br /> Number Description Date Time c�mWatecrrab Air Solid Coats / Notes <br /> 68089 <br /> r <br /> 3 � <br /> 68090 <br /> EI I <br /> a o, <br /> 3 I 68091 <br /> mw7v� �s log IZ3 <br /> In W1 6S .3 68092 <br /> /�,/o, �6yd -�C <br /> lnw 68093 <br /> w i 68094 <br /> `� vat oszlol �Zas' \3 68098 <br /> e Ingo y 8ture) Receivedy (Signature) ua�a! rutr i <br /> . r Da e/Time <br /> Relinquished by ig ureJ Received by (Signature) ` � 1 <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) / Date/Time <br /> Dispatched by (Signature) Date/Time Received for tabarato <br /> Method of Ship gent Labo ory Name <br /> Special Instructions Ica}* WoOo"PRESERVAMON i hereby au raze the performance of the above indicated work <br /> (1,00n CnIdDITIrIM UMPRIAT; 00 <br /> Elrp nearr�y°r`r CiU1��ni�aCfSJ <br />
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