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ARCHIVED REPORTS_XR0009158
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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P
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PERSHING
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4501
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3500 - Local Oversight Program
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PR0545651
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ARCHIVED REPORTS_XR0009158
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Entry Properties
Last modified
5/6/2020 11:40:00 AM
Creation date
5/6/2020 11:14:29 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009158
RECORD_ID
PR0545651
PE
3528
FACILITY_ID
FA0002479
FACILITY_NAME
7-ELEVEN INC #17334
STREET_NUMBER
4501
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11017004
CURRENT_STATUS
02
SITE_LOCATION
4501 N PERSHING 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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4&M = = = M 56 ■r <br /> Vm6r = <br /> Chain of <br /> Custody Record Severn Trent Laboratories, Inc <br /> STL-4124 (4700) <br /> Chenj---, Prole an g r Date Chain of Custody Number <br /> L61 aP s 3 <br /> Address Tel one Nu ber(Area Code)/Fax Number Lab Number <br /> 1 f ( Z S� _4? Page of <br /> fe-crty State Zip Code site contact Lab Contact Analysis(Attach fist if <br /> f� <br /> l a f� r /'� mores ace is needed <br /> CA Project Location(S ate) 7 Carrier/Waybill Number <br /> L lA SWI N 17 3 3 { Special Instructions/ <br /> ContractfPur�ase OrderlQuote No Containers& Conditions of Rereipt <br /> C`�!�(_[� Matrix Preservatives <br /> ° <br /> Sample/D No and Descnpbon a <br /> Date Time m a G <br /> (Containers for each sample may be combined on one line) CO COO <br /> x x <br /> V V ��J 1 `• JV <br /> RA W <br /> Possible Hazard Identification Sample Disposal (A tee may be assessed if samples are retained <br /> 15don Hazard ❑ Flammable ❑ Skin Irritant ❑Poison B ❑ Unknown ❑Return To Client Disposal By Lab ❑Archive For Months longer than 3 months) <br /> Tum Around Time Required OC Requirements(Specify) <br /> ❑ 24 urs ❑ 48 Hours ❑ 7 Days ❑ 14 Days ❑ 21 Days ❑ Other <br /> Rebn ishe By Date Time f Received ByDate Time <br /> I1512 r <br /> 2 Relingwshe y Date Ti2 erved By Date Time <br /> me <br /> kZ'f V:k mz <br /> 3 nquished By ate ime 13 Received By Date Time <br /> — <br /> o ns V . � f ISZ7D <br /> DISTRIBUTION WHITE Stays wdh e am e CANARY Returned to Client with Report PINK Field Copy <br />
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