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ARCHIVED REPORTS_XR0009117
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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4555
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3500 - Local Oversight Program
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PR0545652
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ARCHIVED REPORTS_XR0009117
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Entry Properties
Last modified
5/6/2020 4:08:11 PM
Creation date
5/6/2020 3:41:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009117
RECORD_ID
PR0545652
PE
3528
FACILITY_ID
FA0003638
FACILITY_NAME
JEMCO VENETIAN CARDLOCK
STREET_NUMBER
4555
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11017001
CURRENT_STATUS
02
SITE_LOCATION
4555 N PERSHING AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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LSauers
Tags
EHD - Public
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4r <br /> SIDE 2TOR <br /> ® t=" CHAIN OF CUSTODY RECORD 3 2 5 6 g COMPLETE <br /> INSTRUCHONS <br /> Ship To: r_fi r ` r ._ Project Name: "' FOR LABORATORY USE ONLY Am,i�t <br /> Address:_ Project Number: ���� Laboratory Project# <br /> 4111 4132 <br /> ( F , ,r r. r_ Storage Refrigerator ID 0 7,1-1 1 Z 41&1 <br /> Project Location: (State) - Storage Freezer ID 41 Sham Method <br /> 420 <br /> 5022 <br /> Sampler Name , Signature ,n+ ,. PPE Wom in Field f E <br /> (5 / , . • �` I _ (/� /� 801 <br /> I hn lashed fC <br /> By Da mne Received By or Method of Shr ent/ShrP�ent I.D nn� � <br /> CR' !" 808 <br /> Relinquished By t Date WT, R oekS By or Method Sh ipment I D I vne 61100 <br /> Y 1 1 s > > 1 625 <br /> Rehnqunshed By DawTtme Received By ot Method of Shipment/Shipment I D baterrime 8010 <br /> Bois <br /> 8013 Mod <br /> Sample Disposal Level of 1 ❑ 2 ❑ 3 ❑ 4 ANALYSES RL+QMTED B0 <br /> 80211 <br /> (check one) Write am <br /> (see Side 2) am <br /> El ❑ 6 ❑ 7 Analysis Method � ' 8100 <br /> ;< Laboratory Standard ` am <br /> [� 831 <br /> Other SAMPLE INFORMATION r, ,°,n,ry <br /> 1 \ BTEt <br /> Ch <br /> Descnptlon Container(s) c\ CLP(amiss Side 2) <br /> FOR LABo"WRY USE ONLY Sample ID Matrix Pres coo <br /> IBb lD Number Date Tune Locator Depth # Type Type Type TAT <br /> color <br /> cerducovity <br /> WO <br /> T e_- L-f X FWhpow <br /> Fluoride <br /> 2 , , r� n + !!a,`- r�S i�' i I General ihtrnerel <br /> Flex Chromium <br /> i 3c: itahB Beare <br /> 4 F" r. ,� , i,_ ymetal&I Wd ry' <br /> Metds 6010' <br /> } . t '; — 7.- � � �[ � Metals PP, <br /> S Metals Title 22: <br /> fTTLO LOW <br /> 7. i, i r !l [' ' / k 8TLC Lew" <br /> { /L l ( !w !'f�f': — s y+i I (see side 2) <br /> ! Nkram <br /> i Write <br /> Org Lead <br /> 9 1J r ~ — j !� LalTl )C j( org Mercury <br /> Perosnt Maeturs <br /> _ car- y X Percent Solid <br /> 10 PPerchlorate <br /> (7� / � { y - /vim /.� <br /> Special Instructions/Comments Container Types A=1 Liter Amber TAT(Analytical Turn Around Tune) Phosphates <br /> B=Brass Tube Cassette 1=24 hours 2=48 hours Phosphorus <br /> ✓ 'fr <br /> - ' <br /> ' G--Glass Jar P=Polyethylene 3=l week 4=2 weeks 5�ff� <br /> K `5 ' 0--Other V=Voa Vial 0=Other TCLvoA <br /> Semwoa <br /> I FOR LABORATORY USE ONLY Sample Condition Upon Receipt. SEND DOCUMENTATION AND RESULTS TO(Check one) Pestipde <br /> '[� Project Manager/Office �_C.U (� P'' r'4 f Told hardness <br /> ❑ Client Name Tome Sobd. <br /> TPwo <br /> Company � r L Com' P"r �,!� Tss� <br /> j f(i Tuebdrty <br /> Address /� ` ~ r •specify Total or unsolved <br /> ' Phone FAX <br />
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