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ARCHIVED REPORTS_XR0010131
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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SHAW
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1500
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3500 - Local Oversight Program
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PR0545688
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ARCHIVED REPORTS_XR0010131
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Entry Properties
Last modified
5/21/2020 3:38:07 PM
Creation date
5/21/2020 10:05:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0010131
RECORD_ID
PR0545688
PE
3528
FACILITY_ID
FA0003634
FACILITY_NAME
CANTEEN CORPORATION
STREET_NUMBER
1500
Direction
N
STREET_NAME
SHAW
STREET_TYPE
RD
City
STOCKTON
Zip
95205
APN
14326008
CURRENT_STATUS
02
SITE_LOCATION
1500 N SHAW RD
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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LSauers
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EHD - Public
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4 ' CHAIN CHAIN OF CJSTODY/LABORATORY ANALYSIS REQUE�ORM <br /> Arta <br /> a•empkoy�e s eI canes„W 3302 East University Drive,Suite 4•Phoenix,AZ 85034•(602)437 2001 •(BOD)695 7222 x09•FAX(602)437 5308 DATE —2 LtL PAGE__ _01 <br /> PROJECT NAME Ifs Q 4 # C— q?– �- ANALYSIS REQUESTED <br /> PROJECT MANAGER 7 =' d <br /> (} [ � h Ul <br /> COMPANY/ADDRESS d � JRAQ Q• z L� �m u p c C96 ❑ <br /> L60—t0061 PHO EIFA 7_.O� 7~ 0 a o =a�ao 0- <br /> ❑❑ �q <br /> LL m a aro _a m mQj <br /> SAMPLER'S SIGNATURE m p rU m _q °— <br /> w ” ro C^ C o m Co m co o r� <br /> m q CD_QV (b_QV m� 2 ZGj Q 4 4] <br /> SAMPLE LAB pRESER J•� a U m m^�4r o a`T ro U Z <br /> I D DATE TIME I D MATRIX VATION Z �� _�� �U �} QQ REMARKS <br /> ?-qlofi 101701" 00 � � X <br /> w &z z,4 og to1;6 1 On- 3 X <br /> NSW 3 D zqot35 3 -3 <br /> c3 LOZZ_g0 012L inoi � <br /> W t3 ZLtdy bis Cos 3 <br /> 9&'Z2qf'9 c4iq006 3 <br /> t zCq 00V 3 <br /> t' 1FeUrk oog <br /> SPECIAL INSTRUCTIONS/COMMENTS REPORT REQUIREMENTS INVOICE INFORMATION SAMPLE RECEIPT <br /> • � n JI n � f/ref PO r 1 Report Report kl�ie <br /> `� "t0 � �II Report[Includes DUPM5 pa# 5hippingVIA <br /> MSD,as required,may be <br /> Ii <br /> /) p p il l e GQ �� �� i ts� charged as samples) Bill To Shipping# <br /> �R �f �0 _ 114 Data Validation Report Condition <br /> ,2 9 J 3 �c 1 [f s B new d- a-kr��Y �`�>r "``-' {includes All Raw Data) r� p <br /> ,A�r�s h �Te ea� �ff 7p� �ri� x + e f b e h�i` IV GLP Deliverable Report Lab No kr�7_ rX'1 rtI 3 <br /> Relinquished By(Signature) I Organization at rr1 Received By(Signature) Organization Da /Time <br /> � TAT(Crrcfe One) <br /> Zip 42 <br /> 00 5TANDARD <br /> Relinquished By(Signature) Organization Date/Time Received By(Signature) Organization Date/Time RUSH TAT - Surcharges Apply <br /> .�-s a� Etd <br /> 24 Hours <br /> Ahib W4, K /6Gv � ❑❑48 Hours <br /> Relinquished By(Signature) Org nlzation Date/Time Ived By(Signature) Organization Da 1FI e ❑72 Hours <br /> t 1 <br /> J <br /> DISTRIBUTION WHITE return to originator, YELLOW lab PINK retained by originator 0702 <br />
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