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ARCHIVED REPORTS XR0005967
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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2081
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3500 - Local Oversight Program
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PR0544590
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ARCHIVED REPORTS XR0005967
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Entry Properties
Last modified
6/21/2019 3:53:43 PM
Creation date
6/21/2019 11:11:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005967
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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J�D§QUOIA ANALYTICAL 680 Chesoke Drive a Redwood City, CA 94063- (415) 3649600 FAX(415)9233 <br /> 1W CHAIN OF CUSTODY ❑ 819 West Striker Ave. o Sacramento, CA 95834 • (916) 921-9600 FAX (916)921-0100 <br /> ❑ 1900 Bales Ave., Suite LM o Concord, CA- 94520•(510) 686-9600 FAX(510) 686-9689 <br /> 1CompanyName: V ISG 12.E 1 �.�i �.�✓��o C awsrlc T. Project Name: <br /> IC uVi kAFe r�res <br /> Address: 36 'sT� ci Billing Address ( 4 different): 3 3 <br /> COY= c.� S� State: c Zi Code: <br /> Tele hone: 3oy',a72-- 36. ZD FAX#: S SC P.O.#: <br /> m <br /> Re n To: Vt C G ��� ,,, Sam er. CL i M—=JiT2E, (]C Data: ❑ Level A(standard) ❑ Level B ❑ Level C Level D v <br /> Turnaround 3 10 WorkingDays ❑ 3 Working Days ❑ 2-8 Hours ❑ Drinking Water [Analyses Requested a <br /> Time: ❑ 7 Working Days ❑ 2 Working Days ❑ Waste Water pit <br /> ° S `� <br /> ❑ 5 Working Days d 24 Hours ❑ Other <br /> Client Date/Time Matrix #of Cont. Sequoia's <br /> Sample I.D. Sampled Desc. Cont. Type Sample 0 & i Comments <br /> I. KF- vi- <br /> .o <br /> 3. K1=--3 y VL 3 <br /> 4. <br /> 6. <br /> 7. <br /> S <br /> a <br /> 8. r <br /> Q <br /> 9_ m <br /> Relinquished By: Dater c� Time. Received By: Date: Time'. <br /> Relinquished By: Date: Time: Received By: Date: erne: <br /> Relinquished B Date: Time: _ Received B L Date time: <br /> Were Samples Received in Good Condition?❑Yes U No Samples on Ice? Q!Yes Q No Method of Shipment_- Paoe of <br />
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