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ARCHIVED REPORTS_XR0007409
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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P
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PACIFIC
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6131
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3500 - Local Oversight Program
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PR0545003
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ARCHIVED REPORTS_XR0007409
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Last modified
11/27/2019 11:35:15 AM
Creation date
11/27/2019 11:18:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007409
RECORD_ID
PR0545003
PE
3526
FACILITY_ID
FA0002324
FACILITY_NAME
Pacific Service Station
STREET_NUMBER
6131
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09746418
CURRENT_STATUS
02
SITE_LOCATION
6131 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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aaasw <br /> FfRETAIL <br /> w '40000MSHELL OIL COMPANY 7§ - <br /> CHA1N of CUSTODY RECORD if <br /> e 4f78197 ENVIRONMENTAL ENGINEERING - WEST Send No Page of <br /> Stle Addreis. (Pr3 I Analysis Required LAB: 5 - <br /> CHECK ONE:(1)BOX ONLY CT/DT TURN AROUND TIME <br /> Shell Engineer prone No 510 Quarterly Monitoring 5461 24 hours [ [ <br /> Site Investigalion 11 5441 48 hour [ <br /> Consultant Name& Address Sal for disposal C ] 5411 <br /> E irlo—olu fl�=cr iC1�t'� IS days (Normal) <br /> 3 't- S 3 y"' Water for disposal [ ] 5443 Other <br /> `^ = i l <br /> Co nsultani Contact. jPhowNo41fo _4~ Air Sampk-Sys O&M [] 5452 <br /> 8—3 3� �1 waver sample Sys O&M �] s4s� NOTE Notify Lan as <br /> pas 0- 9Z -3341 < soon a possible of <br /> Comments G���d(�.Cj r� Other [] 24148 Ms TAT <br /> z <br /> SAMPLE <br /> Sampled By , pry p< Q y B MATERIAL CONDITION/ <br /> fritted Name X Pal 7711.x.,4 _ DESCRIPTION COMMENTS <br /> of <br /> I <br /> Sample 1D Date Sal Watcx Au ccooals pq > I- �4 <br /> ix (� (� oSo <br /> 11 ly- <br /> 3 TAm <br /> Blur rsh By tt printed risme pati /T R&e { ) � Printed name '—/—- -- — Date � <br /> J• �7r/Lc.I Time. s 9[rslL l r Time :it <br /> in luished By (signature) Printed name Date. Received(signarm) !'tinted none Dare <br /> rime. rime <br /> Rclinquished By (signature) Phntcd name a Received(signature) Printed name Date <br /> Tim - <br /> e iFW <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN-OF-CUSTODY WITH INVOICE AND RESULTS <br /> 4A RLvtiNm Date 10/15/91 <br />
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