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ARCHIVED REPORTS XR0006118
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 XR0006118
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Entry Properties
Last modified
6/21/2019 1:33:18 PM
Creation date
6/21/2019 10:46:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006118
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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SJGOV\wng
Tags
EHD - Public
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KIFF 2795 2nd Street Suite 300 /"� <br /> Davis.CA 95616 �/_ / 3 3 <br /> Analytical LLC Lab 530 237 41300 SRG a/Lab No �J Page / of <br /> Fax 530 297 4802 <br /> Project Contact(Hardcopy or PDF To) California EDF Report'? ❑Yes 9m Chain-of-Custody Record and Analysis Request <br /> Company!Address !1 Sampling Company Log Code Analysis Request TAT <br /> CL <br /> � <br /> Phone# Fax# Global ID _ <br /> a <br /> SD G vd GG2G7 t2 hr <br /> Project# P 0 If EDF Deliverable To(Email Address) ; m 11 ❑ 0 <br /> W m 24 hr y <br /> Project Name Sampler Signature a ° W A <br /> w v w m �a to N `n Q ❑ J <br /> Project A rens ' - L_ Sampling Container Preservative Matrix a rr m m m ^6 W =' a w o 48 hr `o <br /> CrH//J .PIGGY N n r'a Q U.1 'I' � p O a r~yn <br /> ¢ a a � � m a � 25 g w ❑ <br /> lC� m L w w "m = O o 72 hr <br /> E m a, _ p m m ui iu x i7 v m m m <br /> p@ o =° U Z o m — m m W a 0 0 b m 'm x = ed w <br /> -Sample Designation Date Time -t a C7 l– r Y 3 * a as s- to n -J > > > CL S Kim <br /> / -T-1v Ihh <br /> rZ 3I I I I I h I I I Y, xi I I 1 01 <br /> e ,r 7— <br /> G �uT fS� <br /> -,,L f-f- 3 a Y <br /> ab <br /> a /l <br /> Relinquished trf Date Ffma Received by Remarks <br /> A/C <br /> T61hqushed,W D to Tune Received by <br /> Bill to <br /> Relinquished by- Date Time Recetv by Labora <br /> (J For Lab Use Only Sample Receipt <br /> 110 f D� 110 <br /> �' /r g: <br /> Temp°C tnd�ds Date Time Therm ID tr coaanr present <br /> V (y�„(J 119 es ! No <br />� bistn'bidmn While-Lab Pink prigtnalar 1.61- 1 TA logO 11 <br /> Rev 051805 <br />
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