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ARCHIVED REPORTS_XR0005441
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_XR0005441
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Entry Properties
Last modified
5/5/2020 2:09:13 PM
Creation date
5/5/2020 1:38:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005441
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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CAST*ANALYTICAL LABORATORY l bXa( sq CHAIN OF CUSTOM <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 (209) 384-1507 <br /> Customer REQUESTEb ANALYSES Method of Shipment <br /> Address 1.40 S 1Jo c'7 save at to) 42462 <br /> City/State/Zip. 5 ;?Q5 S 9 ha Notes 102463 <br /> Phone / FAX- (,-7- OG1� f LLIs W <br /> Prol # P 0 #: v � g r o a 0t02464 <br /> Report Attention 3- tt r � a L, W i <br /> Sampler Signature a m Wm <br /> 02465 <br /> Printed g D i <br /> Z i <br /> Lab ID! SAMPLE ID DATE TIME DESCRIPTIONMOCATION OBSERVATIONS/A02466 <br /> _v4 <br /> '0102467 <br /> } +s <br /> 31%'-_If Rf \t /r <br /> r r <br /> fq w 4 <br /> 102466 <br /> 02469 <br /> MW-to -4 .4 S r <br /> � �1 +t <br /> � 3 - I 102470 <br /> 11 w <br /> W�1 <br /> i 02471 <br /> AW-16 ZILE <br /> 02472 <br /> Total number of ocn <br /> Signature Printed Name Date Time Company Name the 1s <br /> Relinquished by ^ Q T y Nate All special req O 4 4 e <br /> tum times)must be; ' <br /> Received by l U r turn times must <br /> orato ' <br /> Relinquished6y aut0 L Q <br /> 75 <br /> Received by -1)2476 4 7 6 ' <br /> Relinquished by RESULTS DUE <br /> Received by VERBAL WRITTEN <br /> { <br /> r� <br />
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