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ARCHIVED REPORTS_XR0008173
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_XR0008173
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Entry Properties
Last modified
5/5/2020 3:30:20 PM
Creation date
5/5/2020 2:45:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008173
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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Adv <br /> anted CHAIN OF CUSTODY PCORD <br /> GeoEnvironmental, Inc. Date-7 Page t of ` <br /> of Northern Calrfonrta <br /> 1803 West March Lane Suite A Stockton California 95207-(209)95"264 Fax(209)956-0700 <br /> Client .a a _ „ 1 Project Manager <br /> ' -pests Required <br /> Phone Number <br /> Samplers (Signature) ,� Invoice <br /> Project Name V4 AGE <br /> Client ❑ <br /> ' <br /> Sample Location Sample Type No of �� <br /> Number Description Date Time Water Solid Notes <br /> Comp Grab Air Conts <br /> G;O"AY rJ 6w- <br /> / 5 - l O LA <br /> 4-3c- <br /> L,mquis ed y (Signature) ecerve y rgnature t)ale/Time <br /> Relinquished by (Signature) - Receive b (Signature) Da ITime <br /> (?06 <br /> Relinquished by (Signature) Rec rved by obile Labor ory for field analysis (Signature) DatefTime <br /> Dispatched by (Signature) Date(Time Received for Laboratory by DatelTime <br /> Method Shipmen Laboratory flame <br /> Special Instructions 1 7d W �� I hereby authorize the performance of the above indicated work <br /> . <br /> L M IF <br /> .9r8'1q 6 <br />
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