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ARCHIVED REPORTS_XR0007298
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WILSON
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2211
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3500 - Local Oversight Program
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PR0545106
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ARCHIVED REPORTS_XR0007298
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Entry Properties
Last modified
12/19/2019 4:23:49 PM
Creation date
12/19/2019 4:09:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007298
RECORD_ID
PR0545106
PE
3529
FACILITY_ID
FA0003694
FACILITY_NAME
RIVER CITY PETROLEUM CARDLOCK
STREET_NUMBER
2211
Direction
N
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
11707050
CURRENT_STATUS
02
SITE_LOCATION
2211 N WILSON WAY
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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-- ANALYTICAL REQUEST/SAMP,IX CHAIN OF CUSTODY-- LAB TRACKING # ----------------------- <br /> RECORD OF DATERECIEVEb <br /> DEL-TECH GEOTECHNICAL SUPPORT SERVICES LAB INVOICE TO - <br /> ---------------------- <br /> 10624 OLIVE AVENUE,OAKDALE,CA 95361 ...j.aErc�.I. _ . ----- .�__�Pn E --- ?� ---- -----i <br /> OFFICE-(299)-77$157 �� �1Q�Q�.Q <br /> I FAX -(209)647-7744 PH# ....._--)- �.l. CONTACT ----_.... --------------------------------------..........-- <br /> CALEFORNIA CONTRACTORS LICENSE#6573661 CLASS"A"ENGINEERING <br /> OB#i ---------------------[NVO CE 1►._...-------------------P O 1► ....................................... <br /> II,,, „ LAB ANA>:.YSIS REQUESTED SITE SAMPLING MAP <br /> CLIENT CONSULTANT lEA IY' 1 , s 1�aTro <br /> �`11I,f1� <br /> SITE NAME �.. PROJECT '� •o � ) 4D <br /> ADDRESS i_C�IyTYSTez, F O rr1 - � TYk�.I <br /> SAMPLER SIGNATURE <br /> SKIPPED VIA1- WAYBILL <br /> Ww c S t 4 } <br /> ANALYSIS BY TURNAROUND TWE -'1 DAY F W w oHo W W ? <br /> SAMPLE ID 0 DATE TIME CONTAINERS TYPE MATRIX !"`;, ;;, 'I ' I REMARKS/LAB I D <br /> 1) ` 7 - <br /> z) \- I <br /> 3) 1 6Z.2, <br /> 5) l <br /> 6) tym - <br /> 9) ` <br /> 10) <br /> 14) <br /> 15) <br /> 1DATE I TIME <br /> RELAp[IISI�SJBI +' ` LTE, RECErVEnet , /f�� , SAMPLE INTEGRITY/CONDITION <br /> t� (SIGNATURE) /. }' RECEIVED COLD&INTACT / YES NO If <br /> DATE I TIME <br /> REl.GVQUISHED Et / 14�.3'f 81 , ti'C1 AIR BUBBLES IN V O A S 1 YES NO LiN S p <br /> I 7f (SIGNATURE) f�,� / (` {Iv`�/: TIJSTODY SEALS INTACT 1 IES ) NO( 1 N/A s 7 <br /> I A 1:j <br /> DATEITMse <br /> RELINWISHEDI1t REMtVEDBt PRESERYATNESUSED / NES NO <br /> f (SIGNATURE) 1 <br /> NOTE P[XASE ARCHIVE THE SAMMIS SUBMITTED FOR THE FULL HOLDING TIME ALLOWED IJNII-SS OTHER ARRANGEMENTS ARE MADF � (MTBE TAME,E T B E,D I P F TBA) <br /> BB =BAILIE BI ANKS C OI I FCT-D IN THE-IIELD F B =IlELD BLANKS COLLI CTEJ)IN THE I IELD <br /> PINK FIFLD(OPI MIIITFAIFI1OR TOI4BRITHSWPLF5 1FII0N RFTIR%TO(IWNTMITNRPSIITS DFL,TECIICO( FOR1198 <br />
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