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ARCHIVED REPORTS_XR0008177
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_XR0008177
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Entry Properties
Last modified
5/5/2020 3:29:36 PM
Creation date
5/5/2020 2:46:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008177
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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f <br /> _ CHAIN OF CUSTODY <br /> Geological Audit Services , Inc . ODYRECORD <br /> 'r �� EnY/ronmenta Prolesslona/s Date IL-7$"•`H Page _ of <br /> taut West March Lane, Sulte A• Slockton, California•95207 • (209)956-0254 <br /> Client A rr 14/ q.h,y, Project Manager <br /> + ! Bob Map)/ Tests Required <br /> Phone Number <br /> ;-Qq ) 1 5b-0-4Ll <br /> Samplers: <br /> (signature)Project Name 4 i- <br /> Invoice: <br /> r:oMNt May, r GeoAudit <br /> �►� Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Solid No. of •� <br /> Comp. crab. Air Conts. �� ��� Notes <br /> l/„e r, fl y= rgnatura <br /> __ � C ecatve y: ignature <br /> alinq ,u 51a 0 da�^i� 7%A.T QatelTime <br /> slinquiahed by; {Signature) ny <br /> I� 3U rr�/1�11r1 <br /> Rec al o) <br /> DatelTime <br /> iialinquished by: (Signature) �Vif(� <br /> Rectie La story for field analysis: (Signature) <br /> Date/Time <br /> Dispatched by: (Signature) <br /> oaIaJ ime---]-Roceivod for Lebora[or b <br /> Y y <br /> bate/Time <br /> Method o! Shipment: <br /> Laboratory Name <br /> Spacial instructions: A Ipha <br /> I hereby authorize the performance of the above Indicated work. <br /> > > ! ! ! <br />
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