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ARCHIVED REPORTS_XR0004450
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004450
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Entry Properties
Last modified
2/6/2020 4:46:37 PM
Creation date
2/6/2020 3:51:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004450
RECORD_ID
PR0545347
PE
3528
FACILITY_ID
FA0003685
FACILITY_NAME
DBA CIRCLEK, REFUEL PETROLEUM INC.
STREET_NUMBER
419
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21938610
CURRENT_STATUS
02
SITE_LOCATION
419 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\wng
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EHD - Public
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WHF> INC. <br /> Fast Office Box 427 <br /> Oakdale.CA 95361 <br /> CHAIN OF CUSTODY RECORD V1 (209)848-4280 <br /> Project Name: <br /> Number <br /> Samplers(signature): of („1 � � IQ REMARKS <br /> ContainersStation <br /> � 1 <br /> CL <br /> } ; , <br /> Number Date Time o Station Location <br /> l <br /> Ail <br /> 76L lot <br /> LO <br /> Reliti �ed.beyacute} Date ! Time Received ed by(signature): 2'2-1 0(} Relinquished by(signature}: Date 1 Time Received by(signature): <br /> Coy or Agency: <br /> mp /YCV <br /> Company or Ag <br /> r Company or Agency: Company or Agency: <br /> ', 4 <br /> Relinquished by(signature): Date 1 Time Received by(signature): Relinquished by(signature): Date ! Time Received by(signature): <br /> Company or Agency: Company or Agency: Company or Agency: Company or Agency: <br /> Relinquished by(signature): Dale 1 Time Received by(signature): Date ! Time Remarks/Shipping Information <br /> Company or Agency: Company or Agency: <br />
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