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ARCHIVED REPORTS_XR0012031
Environmental Health - Public
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EHD Program Facility Records by Street Name
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W
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WILSON
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101
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2900 - Site Mitigation Program
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PR0541653
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ARCHIVED REPORTS_XR0012031
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Entry Properties
Last modified
10/10/2020 10:53:15 PM
Creation date
7/9/2020 8:30:10 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012031
RECORD_ID
PR0541653
PE
2965
FACILITY_ID
FA0023871
FACILITY_NAME
TOP FILLING STATION
STREET_NUMBER
101
Direction
S
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
15125307
CURRENT_STATUS
01
SITE_LOCATION
101 S WILSON WAY
P_LOCATION
01
QC Status
Approved
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LSauers
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EHD - Public
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• CHAIN OF CUSTODYWCORD <br /> Advanced , , t� 2;;:;,GeoEnvironmental, Inc. Date �.- Page of <br /> 4005 North Wilson Way-Stockton California 95205 (209)467-1006 Fax(209)467 1118 <br /> Client r Project Manager <br /> �, f r � 1 14 , � i g �'� Tests Required <br /> Phone Number `�J f <br /> Samplers (Signature) „�t�A Invoice <br /> AGE <br /> Project Name Client <br /> U <br /> Sample Location Sample Type Solid No of r�� ,t Notes <br /> Number Description Date Time Water Air Conts <br /> Comp Grab <br /> L FT - I I I I <br /> e uis a ( ignature � eceive y (Signature) <br /> Date/Time <br /> Relinquished by (Signature) Received by (Signature) DatelTtme <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datef rime <br /> Dispatched by (Signature) Date/Time ve r Laboratory �D7ate/Time <br /> (/- .2G, <br /> Method of Shipment r L/ I / Labor tory Name <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />
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