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ARCHIVED REPORTS_XR0005716
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_XR0005716
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Entry Properties
Last modified
5/5/2020 3:38:19 PM
Creation date
5/5/2020 1:49:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005716
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
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EHD - Public
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CAS*E ANALYTICAL LABORATORY `'' �� ) CHAIN OF CUSTODY <br /> Location 2333 Shuttle Drive, Sidg 9081909, Atwater, CA 95301 Certificate No 2079 � <br /> Mailing Address 2333 Shuttle Drive Atwater, CA 95301: <br /> 'e+ PAGE n <br /> m <br /> a <br /> Phone {2031 384-2930 - Fax (209) 384-1507 CD� <br /> CU tomer A4ytkk-P—A (e—nt 'j\yno- lrU'_T \t +` _ "J !1,gL -1 Method of Shipment <br /> Address �� 1�-..Lh�t� �t�-�" � �I '� <br /> QtylState/Z!p G a <br /> 9 W g , Notes <br /> Phone i FAX `]" w i w cc ''1 o r+ <br /> Prol # IPO # 0 <br /> Report Attention J � �$ � � w r <br /> Sampler Signature _ a <br /> Printed °' ? <br /> SAMPLE ID DATE TIME DESCRIPTIONILOCATtON 08SERVAT�IONSIRE.MARKS <br /> (D <br /> ro <br /> ''�'1- Y,tbif i. :q 47855 f r <br /> --4T-�i <br /> f _ <br /> W <br /> 1 1 2 4} iliY <br /> Q <br /> > N <br /> 1 � � <br /> ,4 ueJ <br /> Total number of containers submitted to <br /> M1'tare r1� ad Nattis _ bate Tlma- -0 t'0 Ni-00 iL ft laboratory <br /> Relinquished by Note All special requests(e g quick <br /> turn times)must be cleared through <br /> Received by 04 `1 authorized laboratory personnel <br /> elinqut5hed by m <br /> is t } cn <br /> Received by r+ m <br /> N <br /> Relinquished by „ , ,1; RESULTS DUE <br /> VERBAL WRiTTE% <br /> nece�yed by ,- -� , _ <br />
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