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ARCHIVED REPORTS_XR0011434
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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FREMONT
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4100
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3500 - Local Oversight Program
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PR0545177
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ARCHIVED REPORTS_XR0011434
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Entry Properties
Last modified
1/13/2020 5:21:52 PM
Creation date
1/13/2020 4:17:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011434
RECORD_ID
PR0545177
PE
3528
FACILITY_ID
FA0002123
FACILITY_NAME
GREWALS GAS & LIQUOR*
STREET_NUMBER
4100
Direction
E
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95215
APN
14333046
CURRENT_STATUS
02
SITE_LOCATION
4100 E FREMONT ST
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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CASTLE ANALYTICAL LABORATORY ��� � z � GHAIN OF CUSTODY <br /> Location: 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No. 2079 <br /> Mailing Address: 2333 Shuttle Drive, Atwater, CA 95301 PAGE <br /> OF� <br /> Phone: (209) 384-2930 - Fax: (209} 384-1507 <br /> Customer; 9 REf1UESTEO ANALYSES Method of Shipment: <br /> Address: rj y C n <br /> CitylStatelZiP: fi�:: Y? C9,621L<; <br /> Phone 1 FAX: <br /> G -//]B a b �3 Q NOte5: <br /> Proj # I P.O. #: C'�Y Gt j �S (i` w a e o � (J1 <br /> Report <br /> Report Attention: LtV W _ a JJ <br /> Sampler Signature: J <br /> a m <br /> � <br /> Printed: u �- <br /> m - `� <br /> y <br /> - J <br /> c� <br /> Z <br /> Isb ID# SAMPLE ID DATE TIME DESCRiPTIONILOCATION <br /> 6.0546 <br /> � < 60547 <br /> L -- - <br /> Y <br /> - 60.548 <br /> - -- -- <br /> AOF JO <br /> PIA <br /> 0 - <br /> V l i I�,• <br /> o SPACE AB <br /> Total number of co talners submitted t6 <br /> I tore Printed Name Dake Time co1T117i ftp k'tan�e �_ the laboratory` Relinquished by; } � - I �~. '— Note:All s ecial re nests(e <br /> �°S � �)8 'J/.),/I1 /1, P 4 g.quick <br /> Received by; � ? �' /f�r:�L Y r� �: Ci` � Ls� � �!��'C t c r _' °�� furs times)must he cleared through <br /> ~�--''� authorized laboratory personnel. <br /> Relinquished by: � ---.Y.-_....._. rY P <br /> Received by: <br /> Relinquished by: w RESULTS DUE: <br />` Received by: VERBAL WRITTEN <br />
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