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ARCHIVED REPORTS_XR0007931
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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P
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PACIFIC
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4405
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2900 - Site Mitigation Program
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PR0542364
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ARCHIVED REPORTS_XR0007931
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Entry Properties
Last modified
5/4/2020 3:55:32 PM
Creation date
5/4/2020 3:08:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007931
RECORD_ID
PR0542364
PE
2960
FACILITY_ID
FA0024340
FACILITY_NAME
PACIFIC CAR WASH
STREET_NUMBER
4405
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11024014
CURRENT_STATUS
01
SITE_LOCATION
4405 PACIFIC AVE
P_LOCATION
01
QC Status
Approved
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LSauers
Tags
EHD - Public
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r,.p■ �� +ri�ri �� 7ABORATORY <br /> � tti� � � � � iti Ili � <br /> CAS E ANALYTICAL �-���, a()q. of CHAIN OF CUST m <br /> Location 2333 Shuttle Drive, Bldg 9081909 Atwater CA 95301 Certificate No 2079 <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE OF� <br /> Phone (209) 384-2930 - Fax (201)} 384 1507 <br /> Customer 61vanced REQUESTED ANALYSES Method of shipment <br /> Address YQ N W16al UY(t <br /> City/State/ZIP k C Z ��- �, x � w C OV Gfrl'11(Ylf' <br /> Phone / FAX , c - j 7�!?�f w Notes <br /> Pro 11 I P O # / ul p uj = w cn z <br /> 1 ��.0 t {�G c: VVASh °` m _j a m m o ° <br /> � p U <br /> Report Attentionim a� lLi a °ui <br /> a a r3 o <br /> Sampler Signature a '' 1() W 29637 <br /> Printed 2 i E <br /> Lab ID# SAMPLE ID DATE TIME DESCRIPTIONILOCATION z _ 29638 OBSERVATh <br /> LJ y __29639 -- <br /> MW z 29640 <br /> r <br /> aJLIW LP 13CQ 29641 <br /> } Sh - 29642 <br /> 4F M07 <br /> 29643 _ w <br /> 4 <br /> ttow 19 29644 -- <br /> { MW IDA <br /> 29646 <br /> t m ab - - <br /> 29646 <br /> i 29647 <br /> Total number of containers submitted to <br /> i ature Printed Name Date Time Company Name the laboratory <br /> Relinquished by �14d ! ZS /,Q Note All special requests(e g quick <br /> Received by [��c [�� 1�26�co 1� � turn times)must be cleared through <br /> authorized laboratory personnel <br /> Relinquished by <br /> Received by <br /> Relinquished by �C�� 1 nn1T�1���t Cr 1 RESULTS DUE <br /> Received by Jt ,il�iUl i flv Ft VERBAL WRITTEN <br /> CONTa ARS , / <br /> N-Ulrf- feCL11Wc SC�iu1 4 rnlc,tF J ' Ot. ini,;r�� �. Y <br />
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