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ARCHIVED REPORTS_XR0008164
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_XR0008164
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Entry Properties
Last modified
5/5/2020 3:14:30 PM
Creation date
5/5/2020 2:40:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008164
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
Scanner
LSauers
Tags
EHD - Public
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roti� _ttii■� � ttt� ta,� _� ,r_ �� �_Ell• ��rtarai�_■��� _ i <br /> Advaraeed CHAIN OF CUSTODY RECORD <br /> GeoEfiyironmental, Inc Date page 2- 013 <br /> -,' 4005 North Wftan WaySlocklon,Caldomla 85205 (205)487 1006-Fax(209)467-11 f8 <br /> 1655lo XA � <br /> Ment I, ; <br /> ,�- J Project Manager Tests Regulred <br /> V1 if LLL o <br /> Phone Num er <br /> Samplers (Signature) L Invoice <br /> AGS <br /> Project Name J i, Client ❑ <br /> Sample Location Sample Type <br /> Date Time Water Soltd No of Notes <br /> Number Desc:ritattonAir Conts <br /> Comp" "Gulf r <br /> T <br /> •� �1r'� 1'2y 1i Z''�' .3. r 06109 <br /> r <br /> ( �gnar e 1 a Y l i9n <br /> Qnte/Time ' <br /> s rndufeheL- <br /> by (Signature) WL& ved by (Srgnatur ) r <br /> s inqurshed by (S gnaiure) Received by Mobdo Laboratory for field onalysls (Signature} Oste(Time <br /> Dispatched by (Signature) OatsMme Received for Laborsuxy by Date/Time <br /> Method of Shipment Laboratorry�Ne� <br /> IT r <br /> Special instruegon UOIAS M ��IC 1 hereby authori:a rhe pas forrrranca o3 the sbov Indicated work <br /> reRFqj as ►� !pAk� <br /> GOODtj;lI�I3lrl�v_.�,,, <br /> APPROPRIATE �i �, <br />
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