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ARCHIVED REPORTS_XR0008149
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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_XR0008149
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Entry Properties
Last modified
5/5/2020 3:30:01 PM
Creation date
5/5/2020 2:36:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008149
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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Advanced <br /> CHAIN OF CUSTODY RECORD <br /> --�` GeoEnvironmental, Inc. � � �� °tee <br /> d Page of <br /> 837 Shaw Road - Stockton, California- 95215- (209) 467-1005-Fax(209)467-1115 <br /> Client Pro ect M I <br /> nag r <br /> i 44_1e Vests Required <br /> Ph ;e N mbar <br /> 67 <br /> Sam (Sig ature) Invoice <br /> �( l -� <br /> Project Name l � AG E Chant ❑ <br /> G l <br />� <br /> p yP Sample vacation <br /> Sample 7 e No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp (arab <br /> 1v3 1 <br /> Fie�linq iis e y atur } ICE/to I Receivedy gna ra DatelTlme <br /> IU GOOteLROOF810ty <br /> pROPPJATRHEAf�elingom led by (Signature) ASCROEMMINL&Ik � DatetTi e <br /> » 07Relinquished by (Signature) anaiySlS (Signature) Datelrrme <br /> Dispalf hod by (Signature) Uste/Time Received Laboratory b9. <br /> �QAtelrime <br /> Mothaoi of Shipment Laborat Na a <br /> SpecirI Instructionsk hereby nxa the petf mance of the above Indic Hied work <br /> 1k) 11) AA,�- <br /> RE'C'D SEALED&INTACT VIA ! <br />
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