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ARCHIVED REPORTS_XR0006243
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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P
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PERSHING
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4444
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2900 - Site Mitigation Program
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PR0540885
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ARCHIVED REPORTS_XR0006243
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Entry Properties
Last modified
4/10/2020 3:55:45 PM
Creation date
4/10/2020 3:06:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006243
RECORD_ID
PR0540885
PE
2960
FACILITY_ID
FA0023381
FACILITY_NAME
FORMER EXXON SERVICE STATION NO 73942
STREET_NUMBER
4444
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11022017
CURRENT_STATUS
01
SITE_LOCATION
4444 N PERSHING AVE
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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1 <br /> 1 <br /> CONTRACTOR Do not separate this form the DEALER OR MANAGER <br />' O <br /> dealer manager of representatrvt wdt separate 1 Verity Man hours on the Job Job desc ripiron materia is and equipment <br /> I Perform work utilized and check appropriate lob completed box }• <br /> 2 Complete front of Verification Form 2 Set imprinter total amount indicator for total hours/minutes worked J <br /> 3 Obtain signature of service station dealer manager or then run the soft Copies of Verification Form through Cr Card imprinter .— e <br /> representative 3 Sign and return the soft tickets to contractor You are certifying time <br /> F-- 4 Giveformtodealer manager orrepresentative hewill spent at your location and malerrals only <br />' imprint the(2) soft tickets&return them to you 4 To assist us in evaluating the service performance please answer the Li„ <br /> Z 5 Attach the original soft ticket to the invoice keep remaining 141 Questions and drop in the mail w t <br /> the second soft ticket tot your records <br /> ts <br /> pe <br /> 1 r 7 <br /> �-'a <br /> : � r�` f r �x'c• 1;�.eY7f��`f?§*�'�y y„ `_.�Q.ir�� �"tr, �L�� <br /> # CON}t,�iCO <br /> .� Js Y <br /> C) <br /> A � 1 <br /> 7 <br /> .a <br /> rY <br /> d"+ �AJrlYd � a <br /> rr!h#�•�escnp# a + � LTJ <br /> N 2� <br /> uii., R •- � ta�..T ria^ L U <br /> r {�k�a +ar iA <br /> YrrB��J�(��) '_ ���a�_ � � Q II <br /> LLJ <br /> si�i+��rra�ifgpi�fe i* � '� •: .�F,ar� F� s <br />' ry.�ayr3r.r ,.};✓ +�' -�/ e`er R. °""�.�>rf� � <br /> i <br />
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