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ARCHIVED REPORTS_XR0008120
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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4511
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3500 - Local Oversight Program
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PR0545641
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ARCHIVED REPORTS_XR0008120
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Last modified
5/5/2020 3:37:53 PM
Creation date
5/5/2020 2:22:19 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008120
RECORD_ID
PR0545641
PE
3528
FACILITY_ID
FA0002480
FACILITY_NAME
SHOP N GO 3
STREET_NUMBER
4511
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11023011
CURRENT_STATUS
02
SITE_LOCATION
4511 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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CHAIN OF CUSTODRECORD <br /> Advanced a z-�'t o Z Pae ` of �-- <br /> --- GeoEnv}ronmental, Inc <br /> r 4 Date9 <br /> 837 Shaw Road- Stoc kion California- 95215 - (20 467 1006- Fax (209)467-111 B <br /> Client Protect Manager Tests Required <br /> 411 L41� <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> 1 AGE. j�5' <br /> Project Name Client <br /> I � ❑ <br /> Sample ype , <br /> Sample Location Date Time Water Solid No of <br /> Number Description Comp Grab Air Cants 901559 <br /> I , C�4 -U, �41 I <br /> 90564 <br /> 7e <br /> 90561 <br /> 90562 <br /> ",/t 41X 90563 <br /> Re inqu d y ( i ature ry eceive y tgnature DatelTtm <br /> Reli is a by (Signat Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signatura) <br /> J . 00q 90564 <br /> Dispatched by (Signature) Date/Time Received for Laboratory b L, telTt a <br /> 5 � <br /> Method of Shipment Laboratory NAAe <br /> 90565 <br /> Special Instructions 1 hereby authors 0 the pe lormance of the a <br />
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