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ARCHIVED REPORTS XR0005785
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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1876
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2900 - Site Mitigation Program
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PR0542421
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ARCHIVED REPORTS XR0005785
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Entry Properties
Last modified
6/21/2019 1:23:57 PM
Creation date
6/21/2019 10:16:17 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005785
RECORD_ID
PR0542421
PE
2950
FACILITY_ID
FA0024377
FACILITY_NAME
COUNTRY CLUB BLVD/295950
STREET_NUMBER
1876
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12319101
CURRENT_STATUS
01
SITE_LOCATION
1876 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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I <br /> SAMPLE CHAINO&CUSTODY RECORD <br /> EL-TECH GEOTECHNICAL SUPPORT {pL1.ASL PRINT 0 <br /> ) Lab Analysis by • _ Cr1. � <br /> � 1(1624 OLIVE AVE OAKDALE, CALIFORNIA 95361 LAB INVOI(.I+, TO �,� L r • � <br /> OFFICE (209) 847-8757 — s ' l �� <br /> FAX (209) 847-7744 RECORD ,L_OF PH # <br /> CLIENT / CONSULTANT. �--�— <br /> ������— P O #/ INVOICE# <br /> PROJECT/SITE NAME 1 ANALYSIS REQUESTED SITE SAMPLE MAP <br /> t ri 9E. e ITEMIZED AND CHECKED BEIAW INOT TO SCAM <br /> II <br /> (NORTH <br /> STREET 1%07 ip CITY 4�j 0�4 too STATE C.4 <br /> 1 I HIP VIA M -3 t?o <br /> SAM (PRINTED SIGNATURE) AYBILL# ` _ Tr. <br /> CA <br /> -x "�s - <br /> Ir SAMPLE LOCATION DA TE TIME NVAIBER TYPE +=� <br /> /tib <br /> (lDENTIFfCATfON) AfTHJDAII}R HOUR/ASlN OF (GRAB OR SAMPLE <br /> MATRIX M � <br /> (CONTAINERS LOIMPOsITE J REMARKS/* SPECIAL INSTRUCTIONS BELOW <br /> z 0 rrA �Afer y <br /> S 13 UA, <br /> 31 SV <br /> a) W -Z <br /> s, I � —3 6g <br /> Tj---.6- 91 LL <br /> '' <br /> 9, W.5 1 � <br /> 10 1- <br /> 1 `� �� 1 •'S"PIE IATEGRITI 1 COVDITIOA A TURAAROLAD TI11E is <br /> RELI L�JJED81 �e IYA , '� ! / E,�CRECEI\ED(OLD K INTAC-r 1 1 E4 NO <br /> ATE/TIME E(. 1 ED Bl rslnnAnpe, 4 l <br /> ATE t TIME PRF_SER1 ATI\ES(NED / IES 00 NO ! ISL <br /> }� <br /> (l'STO01 SEAMtNTA(T r 1 ES � � NO WA � !� <br /> r l <br /> RELINQUISEEED B\ ae',laTiMr ATE!TIMRE(E11 ED BI E AIR BITBBLE.4 IN 1 OM1 S ! I ES } NO { 1 LINE N <br /> aw�ATuen ATE/TI'1TE <br /> L/� <br /> !� / ` TE RA AROL\D TIAjE CIIPCAO tit <br /> RELIN(,IIISIIFDBI ,sN�Allkr ATE/TINIF hCh111tDBfV L{BORAT0RI IOTFTIMIAXMI TI,I£ <br /> ATFrT['1TE Ta IRELIR � � JS IIGI'R � } � DA1 � � 1{f [EAI <br /> ,smp T ABORAfORY SANIPLM ARLHIVIN(. IVII L Bfs 3U DAYS MRO11 1HM I)ATP SANIIll F 1VAS(.OI 1 M(.fMD, I NI FSS OFHMR ARRAII(,M14M\IS 1Rl:11A1)M �� + <br /> PT M %E RMTLRN DMT.-MH S ICH L.HMSf AND BLUE 1(.M AS S(X)\ AS POSSIBI L fHA! K 1()L <br /> — Pink - Field Copy 1 White & Yellow - To Laboratory with Samples / Yellow - Return to Client with Result\ DMI 1 M(.H MOR11 ( (I(. <br />
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