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ARCHIVED REPORTS_XR0011319
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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F
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FREMONT
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1401
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3500 - Local Oversight Program
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PR0545145
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ARCHIVED REPORTS_XR0011319
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Entry Properties
Last modified
1/9/2020 11:33:00 AM
Creation date
1/9/2020 11:15:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011319
RECORD_ID
PR0545145
PE
3528
FACILITY_ID
FA0003820
FACILITY_NAME
VALLEY WHOLESALE DRUG
STREET_NUMBER
1401
Direction
W
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95203
APN
13525031
CURRENT_STATUS
02
SITE_LOCATION
1401 W FREMONT ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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AML <br /> — ---- CA UPLE CHAIN OF CUSTODY -- LAB.TRACKING #: <br /> 1BF DATE RECIEVED, <br /> 9907000435- DEL-TECH SVC <br /> LAD_INVOICE TO. <br /> DEL-TECH G) <br /> 10624 OLIVE AVENtFE,C 6-Al <br /> OMCE-(W9)9474757 AUG 2 1 1999 1.1stlPl- I N <br /> FAX -(209)847-77" 46 CONTACT: <br /> PH.# CO <br /> I+[1 <br /> CONTRACTORS LICFA!5&SW/ff-"qMGu,4EERING <br /> JOB INVOICE P-0.# <br /> ;W.jIl!lllll;ll!j:ll�ji LAIL ANALYSIS REQUESTED SITE SAMPLING <br /> I .i.l!JII _G MAP <br /> CLIENT: v,V41 f) CONSVLTANT-. <br /> SITE NAM:'JAUE"( 4) ' PROJECT: 7-NP- am t <br /> _r vq ad X I I "-A.-)'� <br /> ADDRESS, EERwan, -9r, CITY: 5la-ALlb-t-1 IST_ 0 m - <br /> SAMPLER SIGNATURE: asg Goi 6 2 <br /> SHIPPED VIA: WAYBILL IF: Cp s ] cQ <br /> ANALYSIS BY: TURNAROUND TEME: DAY g91 5 D P-Mo-140 <br /> Mill S"PIZ La v PA TE TWIT COW7"NM TYPE MATJUX. , REMARKS LA <br /> lilld1l 1111 1011. <br /> YYvj,) -7 1111.1342-0 Wpt X__ <br /> -1 4 <br /> '2, 1' 14-t, 410 <br /> 3 <br /> .2 4 -7 -C> <br /> 1 14,;4 <br /> 5 <br /> 9.) <br /> z <br /> 11.) z I I <br /> 12.)l <br /> 13.)l <br /> 14.)i:awl <br /> OUISFU)BY: RECENEDBY! SAMPLE INTEGRITY CONDITION <br /> r90 (SIGNATUM <br /> (61 ca- I I zo RECEIVED COLD&INTACT I YFS_jX) NO <br /> DATEIT11WE <br /> L <br /> SAMPLE I" <br /> L5 <br /> INTEGRITY�TRE, S I r , <br /> CE D 'L" NTAI <br /> IV' <br /> REL04QUISHWIPY: U I RFCETVMJBY: AIR BUELoLFsINV.0.A_'S / YES ( NO LINE <br /> S LS I T r <br /> EA INTACT 7 <br /> 1 (SIONATURE) I CUSTODY SEALS INTACT I YES NO( )_ A <br /> TIME SE SUs Y, <br /> RKEWED BY: 71 7 PRESERVATIVES USED I YFShj!f:::J�}NO ( 1_ <br /> 1;7�1 TypE2gPgfAERVATlVE(SI: <br /> NOTE- PLEASE ARCHIVETIFE SAMPLFS SUBMD-rPp FOR TtIP F1.111.HOLDING TIME ALI.OWFt),UNIX-SSOTHER ARRANCPMFNTS ARF MADE. (M.T.B.P...T.A M.F.,KT.R.E..,D.I.P.E..T.B.A.) <br /> B.E.=BAII-FIR BI.ANKSCOI-1.1-'Cn-DINI'I[F-,IIF-I.D. <br /> PINK-FIFLDCOPY' WHITE&FELLOW.TO LAR.WITH SAMPLES %'El,LoW-RETURN To cl.3ENT"'IT[[RF-I;U[.TN DFI.-TECII C.0-C,FORM 911 <br />
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