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ARCHIVED REPORTS_XR0008901
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_XR0008901
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Entry Properties
Last modified
6/1/2020 2:36:08 PM
Creation date
6/1/2020 2:19:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008901
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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40 <br /> ( Advanced CHAINOF PUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 9 26 b Page of <br /> 4005 North Wilson Way-Stockton,Calif0mia-95205-(209)467-1006-Fax(209)467-111 a <br /> A ( y <br /> Client {l � � P ect Marlqqer <br /> L(L 00i Tuts Required <br /> Phone Number <br /> Samplers (Signature) Invoice, <br /> Protect Name C�l �F, — VA-PJ &I AGE <br /> �7 Client ❑ <br /> Sample location Sample Type <br /> Number Description Date Time Water Air Solid No <br /> � , Notes <br /> Comp Grab i <br /> �( r 4®9fi7 <br /> r1��-r I►�f. s►�ik� �i( T -t� ]( 48968 <br /> V C A P,II ICT;i 5 ()TI#1 R <br /> i <br /> IT,iii `$0fi <br /> :ee <br /> ,g ature ese ve y gnature <br /> -� DatelTeme <br /> nqurshed by (Skgnature} Received by (Signature) <br /> Date/Time <br /> Relinquished by (signature) Received by Mobile Laboratory for field analysis (Signature) AS- i AT <br /> [7atelTkme <br /> Dispatched by (Signature) Date/Time Received for Laboratory <br /> r ) �� Date/Time <br /> Method of Shipment �J Lab r to ame <br /> PAL Nr U I � � r• 1� <br /> Specla)Instructions ° <br /> rjJ r it �'� 1 hereby uthorrze th parlor ance of the above Indicated work <br /> �f ViSTf�iY r <br /> t` i"tiw 'R it <br /> r' I I1 <br />
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