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ARCHIVED REPORTS XR0011140
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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D
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DR MARTIN LUTHER KING JR
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701
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3500 - Local Oversight Program
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PR0544217
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ARCHIVED REPORTS XR0011140
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Entry Properties
Last modified
3/4/2019 11:21:58 PM
Creation date
3/4/2019 4:36:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011140
RECORD_ID
PR0544217
PE
3526
FACILITY_ID
FA0002512
FACILITY_NAME
GSG GAS & MART
STREET_NUMBER
701
Direction
E
STREET_NAME
DR MARTIN LUTHER KING JR
STREET_TYPE
BLVD
City
STOCKTON
Zip
95206
APN
14734311
CURRENT_STATUS
02
SITE_LOCATION
701 E DR MARTIN LUTHER KING JR BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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Advanced CHAIN OF CUSTOWECORD <br /> ( ' t <br /> Z7�`� � u Date Page C '� / <br /> GeoEnvironmental, Inc. <br /> 837 Shaw Road -Stockton, California-95215- (209) 467-3006 - Fax(209)467-1118 <br /> Client Protect Manager <br /> r J Tests Required <br /> Phone Number <br /> 2 ao <br /> Samplers (Signat re) Invoice <br /> 1/ a� <br /> Protect Name AGE <br /> Client ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Air Solid Conts 1 Nates <br /> Comp Grob <br /> 78$57 --- <br /> i <br /> �zo I d �� 78858 <br /> Y 78859 <br /> VOACS1 QQ METALS 0TH R <br /> C% inn nQW1111ril <br /> PRESER1rATI id <br /> %I JUV <br /> J <br /> �4 D SPACE ABSENT CONTAINER <br /> Relinqu shed rgnature Received by (Signature) Date fine <br /> r� <br /> Aeiinquiahe b gnatur Reoeived by (Signature) <br /> �� T Date/Time <br /> t J! <br /> Relinquished by (S gnature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (signature) ate/T[me Received for La oratory by DatelTime <br /> Method of Ship me Laboratory Name <br /> C 44 <br /> Special instructions t hereby au rize the pe ormance of the above indicated work <br />
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