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ARCHIVED REPORTS XR0005956
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2081
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3500 - Local Oversight Program
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PR0544590
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ARCHIVED REPORTS XR0005956
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Entry Properties
Last modified
6/21/2019 2:09:39 PM
Creation date
6/21/2019 11:02:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005956
RECORD_ID
PR0544590
PE
3528
FACILITY_ID
FA0003932
FACILITY_NAME
KWIKEE FOODS
STREET_NUMBER
2081
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12315225
CURRENT_STATUS
02
SITE_LOCATION
2081 COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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❑885 Jarvis Drive organ Hill, CA 95037 • (408) 776-9600 • FAX (408) 782-6308 <br /> ..QUOTA ANALYTICAL Q 819 Striker Ave. e 8• Sacramento, CA 95834• (916) 921-9600 FAX (916) 921-00 <br /> ❑404 N.Wiget Lane•Walnut Creek, CA 94598 (925) 988-9600 FAX (925) 988-9673 <br /> CHAIN OF CUSTODY U 1455 McDowell Blvd. North, Suite D o Petaluma, CA 94954 • (707) 792-1865 FAX (707) 792-0342 <br /> 0 1551 Industrial Road m San Carlos, CA 94070 • (650) 232-9600 FAX (650) 232-9612 I <br /> Company Name: [-117 C�r_ Project Name: t�,A <br /> Mailing Address: u e% Billing Address (if different): _ <br /> City: Vii S Zfp1�5 State: C Zip Code:_ ZS 2— <br /> Telephone: Z�-7-7Z _ �'� FAX #: s( f?D.#: -Ape) <br /> Report To: Id 1 014 V1 Sampler:VrQC Data: Level D (Standard) ❑ Level C U Level B CJ Level A v <br /> Y <br /> Turnaround A 10 Working Days ❑3 Working Days 0 2-8 Hours U Drinking Water Analyses Requested 6- <br /> Time: ❑ 7 Working Days ❑2 Working Days ❑Waste Water <br /> U 5 Working Days 0 24 Hours ❑Other <br /> Client Date/Time Matrix # of Cont. Sequoia's � <br /> Comments <br /> Sample I.D. Sampled Desc. Cont. Type Sample # <br /> O <br /> 2. ) <br /> 3. fir. —D a <br /> 4 lr � yar <br /> 5. <br /> 6. K i` <br /> 7. Kf- G Q <br /> 6 <br /> 8. . <br /> d1 <br /> 9. <br /> 10, <br /> Relinquished By: Date: 1� U Time: C f0 Received 4: ate: Time: <br /> Relinquished By: Date: Time: Received By: Date: Time <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> Wefe Samples Received in rood Condition? D Yes U No Samples on Ice? U Yes U No Method of Shipment Page of <br />
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