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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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INTERNATIONAL R IA Control No. 2 7 616 3 <br /> TECHNOLOGY ' <br /> ANALYSIS <br /> 5T FOR AN � a <br /> REQUEST , , . <br /> ON C!C Control No.�.._ <br /> CORPORATION <br /> PROJECT NAME= <br /> '�— - ioC 14 DATE SAMPLES SHIPPED i <br /> PROJECT NUMBER 1�1�tS3tlt1 LAB DESTINATION �•_ to k <br /> PROFIT CENTER NUMBER_ '~'`j - LABORATORY CONTACT <br /> 8 <br /> M t. L-= SEND LAB REPORT TO ^F <br /> PROJECT MANAGER r, <br /> 'T T <br /> BILL i0 -- <br /> ,' ILI E ------ - <br /> P"� I DATE REPORT REQUIRED <br /> PURCHASE ORDER NO. <br /> PROJECT COisTACT Vitt( d <br /> IA' PROJECT CONTACT PHONE NO. Il— r tl <br /> ,i <br /> k <br /> H <br /> Sampfa Plc. Sample Type Sample Volume Preservative Requested Testing Program Special Instructions <br /> —5n1 l 1' Ils7 L— CCv L_ t��I h _ <br /> r 1Ar1 C� 1 ;._!tn 11 <br /> _1• 4 2k04 <br /> r r <br /> A _ <br /> f, <br /> r <br /> +I ec1•s Cctfie ro uiremu <br /> nts must be <br /> TURNARQUND TIME REQUII7ED: (Rush must be approved by the Laboratory Protect Manages) QCLEVEL-, submlitteld to alb before begin Ing work.) p q <br /> Norman Rush_� (Subject to rush surcharge.) I Project Sperific <br /> PASSIBLE HAZARD IDENTIFICATION: (Please indicate II samplo(s)are hazardous materials and for suspected to contaln high levels of hazardous subslances.) 4t t 4 <br /> Non hazard Fisrnmable Skin irritant Nlghly Toxic Other- <br /> Non-hazard <br /> ther <br /> _ ., (pleeNe Specify) <br /> SAMPLE DISPOSAL: (Please indicate disposition of sample following analysis.Lab will chargo for packing,shipping,e.chive and disposal.) <br /> ' its <br /> Return to Client Dlsposal by Lab Archive (Indic number of months.) A}." <br /> FOR LAB USE ONLY <br /> Received 6y DatelTime :2 }' i <br /> t20A.1005 'E <br /> �F <br /> - +I <br /> � i <br /> ( <br /> .1 <br />
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