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ARCHIVED REPORTS XR0012590
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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1403
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2900 - Site Mitigation Program
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PR0505513
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ARCHIVED REPORTS XR0012590
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Entry Properties
Last modified
6/20/2019 5:51:30 PM
Creation date
6/20/2019 4:08:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012590
RECORD_ID
PR0505513
PE
2950
FACILITY_ID
FA0006438
FACILITY_NAME
United # 5446
STREET_NUMBER
1403
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12323246
CURRENT_STATUS
02
SITE_LOCATION
1403 W COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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_ •s r ; <br /> i r V.i=ii t <br /> r <br /> �e.J KE ly <br /> INTERNATIONALO 7 <br /> TECHNOLOGY �Epl3SST app ANA�YSIS r1/A Control No. <br /> iU <br /> E <br /> CORPORATION L G 35 <br /> - 1 C/�Control No. <br /> PnDJF('T Ill �` t �-s 1� `l _ DATE SAMPLES SHIPPED <br /> --_- - PROJECT NUMBER ra�� r 4 _ LAB DESTINATION <br />_ PROFIT CENTER NUMBER � LABORATORY CONTACT =I rr D)v,N {5 `? <br /> PROJEL'T h1ANACER ✓'�'1"� SEND LAB REPORT TO <br /> BILL TO <br /> t{r r 1 r = DATE REPORT REQUIHEU <br /> PURCHASE ORDER NO. _ PROJECT CONTACT <br /> 11 , .M <br /> € PROJECT CONTACT PHONE NO:C4-)7� <br /> s -- �- <br /> Sample No. Sample Type Sample Volume Prase vativa }Requeste+Tost:ng Program Special Insvuclions <br /> ,<!3 <br /> 17� Tn ��9x <br /> TLIRfiAROUN6 T14SE REOUIREU: )Rush must be approved by tho Laboralcsy Project f,�anager,y OO LEVEL: (Leve$5 H and 141 sub)ael to surchnTgo;prc)ect specific requirements n,us+be <br /> submitted to lab be'Dre beglnning work.) ?r>•Y'. <br /> Normal _ Rush_. (Subject to rush surcharge,) I-- I1 _ ill Project Specltic <br /> POSSIBLE HAZARD 0ENTIF€CATION: (Please indica'e it samoiefs;are hazardous materials andlor suSpecfed to contain high levels of hazardous substances,) <br /> Non-hazard—�T Flammable Skin Irritant Highly Toxic Other <br /> (Plesse Specify) <br /> SAMPLE DISPOSAL: (Please indicate disposrt'ron ol�mple following analysis.Lab will charge for packing,shipping,archive and disposal} <br /> FieturRtoCllent Ms esal 6 Lab-- Archive (indicate numberot months,y ¢ <br /> P Y �} �a <br /> FQp LAB USE ONLY <br /> Received !� •Q L"W_ 1 _ _ . Date]Tlme <br /> by i - — <br /> WHITE•OriL to accompany samples <br /> r <br /> field 5 <br /> +} <br /> r } <br /> a� <br />
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