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Environmental Health - Public
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3500 - Local Oversight Program
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PR0545741
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
6/8/2020 12:41:45 PM
Creation date
6/8/2020 12:30:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545741
PE
3528
FACILITY_ID
FA0006284
FACILITY_NAME
YAMADA BROS INC
STREET_NUMBER
15406
Direction
S
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
STOCKTON
Zip
95206
APN
18917007
CURRENT_STATUS
02
SITE_LOCATION
15406 S TRACY BLVD
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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E � <br /> W <br /> rt' <br /> ( L Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental' Date f Page Inc. I <br /> _.� 0 <br /> 4005 North Wilson Way-Stockton,Callfomla 95205-(209)467-1006-Fax(209)467-1418 47 <br /> Cr <br /> Client Manager <br /> Tests Required <br /> n <br /> Phone WMber � <br /> F_ <br /> ff <br /> M <br /> S le . { atur invoice: <br /> TS <br /> 3ct Name 1 AGE <br /> Client ❑ <br /> Sample Typeampffa Location No. of <br /> Number Description Date Time Watf?r Air Solid Conts, Notes <br /> Comp, arab. <br /> -- 26440 <br /> + <br /> -, 26441 <br /> 26442 N <br /> . a <br /> ,D <br /> 0 <br /> to <br /> mq i �by. <br /> ---------- TF Oate(Tlmgnature) Received by: (Signature) l]atefTims Co <br /> Co <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analyais: (Signature) DatafTima y, <br /> Dispatched by: (Signature) DatotTime Received for aboratory y: Date/Time <br /> Method 61 Shipment: labor for Nam <br /> ICER PRESERVATION!!T6 eo <br /> Special Instructions: UNUMUN APPROPRIATE , / 2heralbytho za1 or ormance of the above Indicated work, N <br /> MEAD P <br /> -__._ <br />
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