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COMPLIANCE INFO_1988-2004
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0231401
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COMPLIANCE INFO_1988-2004
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Last modified
11/19/2024 10:19:32 AM
Creation date
6/3/2020 9:48:09 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1988-2004
RECORD_ID
PR0231401
PE
2361
FACILITY_ID
FA0006388
FACILITY_NAME
KWIK SERVE
STREET_NUMBER
950
Direction
W
STREET_NAME
ELEVENTH
STREET_TYPE
ST
City
TRACY
Zip
95376
APN
23406002
CURRENT_STATUS
01
SITE_LOCATION
950 W ELEVENTH ST
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2361_PR0231401_950 W ELEVENTH_1988-2004.tif
Tags
EHD - Public
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9 <br />9 <br />Advanced <br />GeoEnvironmental, Inc. <br />837 Shaw Road - Stockton, California - 95215 - (209) 467-1006 - Fax (209) 467-1118 <br />HI N OF CUSTODY RECOR'D <br />Date -q-//-0-3' Page Z of <br />Client <br />Project Manager <br />CA-"��s 04A ler- <br />Tests Required <br />Phone Number <br />Sampler(Signature) <br />q. <br />Invoice: <br />Project Name 1K'VV I' y- S". <br />&C <br />AGE <br />Client <br />Y <br />Sample Location <br />Sampffi T ype <br />No. Of <br />Number Description <br />Date <br />Time <br />W ter Solid <br />Air Conts. <br />Notes <br />vJ <br />Comp. I Grab. <br />�TKJ 16111 j,63 <br />T 1 Corj,9o5b'Ae' <br />TX10/04W-, <br />I -L z 0 <br />/ <br />J <br />3 `. ( Cort ��,' 4 � <br />Ted <br />Re s ad by: (Signature)We—c <br />e —,v E Y—. <br />T6 Rg—n a—t 5—r-eT <br />Date/Time <br />Ppinquished by: (Signature) <br />Received by: (Signature) <br />Date/Time <br />Relinquished by: (Signature) <br />Received by Mobile Laboratory for field analysis: (Signature) <br />A <br />Date/Time <br />Dispatched by: (Signature) <br />Date/Time <br />Received,16VLa—l-yprator, ir by: <br />9fate/Tima <br />l# <br />vlA�k 3 <br />Method of Shipment: <br />ced- oVer niwKv <br />Laboratory Name <br />'Te-ck <br />opeciai instructions: <br />I hereby authorize the performance of the above Indicated work. <br />
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