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ARCHIVED REPORTS_XR0005439
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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2402
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3500 - Local Oversight Program
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PR0545640
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ARCHIVED REPORTS_XR0005439
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Entry Properties
Last modified
5/5/2020 2:17:02 PM
Creation date
5/5/2020 1:37:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005439
RECORD_ID
PR0545640
PE
3528
FACILITY_ID
FA0003900
FACILITY_NAME
PACIFIC PRIDE COMMERCIAL FUEL
STREET_NUMBER
2402
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95204
APN
12506001
CURRENT_STATUS
02
SITE_LOCATION
2402 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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LSauers
Tags
EHD - Public
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.�� WaNNOW iii 010WENEW <br /> CASTOANALYTICAL LABORATORY CHAIN OF CUSTO1 <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 / <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE OF___L/__ <br /> Phone (209) 384-2930 - Fax (209) 384-1507 <br /> Customer Advtlw , 61,10c-l—,0515 s --re C REQUESTED ANALYSES Method of Shipment <br /> Address <br /> City/State/ZIP m x E w <br /> , <br /> G it o a a Notes <br /> Phone 1 FAX _ w <br /> Prol # IPO # t �I Waw W : w 0 <br /> Q a <br /> Report Attention w r U- <br /> 0 <br /> Sampler Signature a $ m r m <br /> Printed U <br /> n -Q, j <br /> Z 16278 <br /> Lab IDO SAMPLE ID DATE TIME DESCRIPTION&OCATION OBSERVATION <br /> 16279 <br /> -/� - S- 16280 <br /> - .q�- 16281 <br /> i &I- -V Sr <br /> 1116282 <br /> 16283 <br /> 16284 <br /> 16285 <br /> 16286 <br /> ' 16287 <br /> 16288 <br /> _ Total number of oonlaEnero sruu.,, __ <br /> nature Printed Name Date Time Company Name the laboratory <br /> Relinquished bye _ 11T--7 Note All special requests(e g quick <br /> Received by �L !� �`i� J� � turn <br /> dimesorized abet be seary red through <br /> .,.,,. <br /> Relinqu+shed by lawwkawfft . 11-1 �tr� <br /> Received by f <br /> Relinquished by <br /> RESULTS DUE <br /> Received by GOOD COMM i IUN <br /> LITIPILIA L VERBAL wRELN <br /> rA%! <br />
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