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ARCHIVED REPORTS XR0006147
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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1856
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3500 - Local Oversight Program
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PR0544589
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ARCHIVED REPORTS XR0006147
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Entry Properties
Last modified
6/21/2019 11:33:03 AM
Creation date
6/21/2019 9:41:49 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006147
RECORD_ID
PR0544589
PE
3528
FACILITY_ID
FA0001909
FACILITY_NAME
STOP N SHOP
STREET_NUMBER
1856
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
123-191-02
CURRENT_STATUS
02
SITE_LOCATION
1856 W COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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0 <br /> ( Advanced CHAIN OF CUSTOD RECORD <br /> " GeciEnvironmental, Inc. (D�6[ -2(, c��3� G Date i3 d% Page <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax A9)467 111a <br /> Client ( �L��, Prosect Manager <br /> AL Tests Required <br /> Phon6 Number <br /> 90`^ — d0 6 <br /> Sample (Signature) V Invoice <br /> Project Name AGE <br /> Client ❑ <br /> Sample Location Sample-Type No <br /> Number Description Date Time Water Dur Solid Contsf Notes <br /> Comp Gra- ! <br /> 6I / or LZI.Sr <br /> i ! <br /> ff <br /> Ut j�07/3C 1 72640 <br /> �- �3 �7 30� 7 . i dj 72641 <br /> r <br /> 72642 G�� � , <br /> rUTXS THER <br /> e n a y { rgnature 'W ec Date/T e <br /> r GOOD lek: CONDITION PPROPRIATF �' ' r <br /> .19 <br /> ReM719ished 6y (S a ure) v ,. , _VIP Datefrime <br /> Relinquished by (Signature) y � <br /> ) Received by Mobile Laboratory for Reid analysis (Signature) Date/Time <br /> Dispatched by (Signature) DatelT me [ReqUggeived for Laborat Oletr <br /> /Time �/f 0016 <br /> Method of Shipment boratory Name <br /> Special Instructions hereby a h ize er#or nce of the above Indicated work <br /> C00% keeeyleW rSea/ems ��� C , <br />
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