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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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WILSON
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2900 - Site Mitigation Program
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PR0521601
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FIELD DOCUMENTS
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Last modified
6/24/2020 4:41:31 PM
Creation date
6/24/2020 2:44:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0521601
PE
2950
FACILITY_ID
FA0014676
FACILITY_NAME
RISHWAIN, RAYMOND
STREET_NUMBER
48
Direction
N
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
48 N WILSON WAY
P_LOCATION
01
QC Status
Approved
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LSauers
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EHD - Public
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( 7 It' t [ <br /> Advanced CHAIN OF CUSTODY RECORD <br /> -- GeoEnvironmental, Inc. Dace 12- Page ( ofd- .g <br /> 837 Shaw Road - Stockton, California- 95215- (209)467-1006- Fax(209)467-1118 y <br /> 1 <br /> Client ( Proje ager <br /> Tests RstIuirec,, <br /> Phone Number <br /> ?-o <br /> Sam7s, (Signature) o` ` Invoice: <br /> Project Name 'p l AGE <br /> Client Ei <br /> Sample Location Sample Type vA <br /> A � <br /> Number Description Date Time Water Air Solid Co. of Notes <br /> Comp. Grab. <br /> s. <br /> v31-1 TL L P <br /> et-t4 <br /> elmquis a y: ignal re) Receivedy: ignature EITE <br /> _ Dete/Time <br /> C�(� <br /> Relinquishe y: (Signatu e) Received by: (Signature) 2Date/Time <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Received fora boratory by: Date/Time <br /> Method of Shipment: Labor�torfy ame 0 <br /> Special Instructions: I hereb thorize the performance of the above indicated work. <br />
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