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ARCHIVED REPORTS_XR0012021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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W
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WILSON
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101
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2900 - Site Mitigation Program
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PR0541653
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ARCHIVED REPORTS_XR0012021
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Entry Properties
Last modified
10/10/2020 11:01:18 PM
Creation date
7/9/2020 8:24:49 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012021
RECORD_ID
PR0541653
PE
2965
FACILITY_ID
FA0023871
FACILITY_NAME
TOP FILLING STATION
STREET_NUMBER
101
Direction
S
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
15125307
CURRENT_STATUS
01
SITE_LOCATION
101 S WILSON WAY
P_LOCATION
01
QC Status
Approved
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LSauers
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EHD - Public
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CASTLE ANALYTICAL LABORATORY ;20 7 7L- Z-_ f=- t_ 4-, CHAIN OF CUSTODY <br /> Location 2333 Shuttle Drive, Bldg 9081909 Atwater, CA 95301 Certificate No 2079 <br /> PAGE_4 OF_L_ <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 <br /> 77) <br /> Phone (209) 384-2930 - Fax (209) 384-1507 <br /> REQUNAL`fSES Method of Shipment <br /> ES A <br /> Customer CA caw <br /> Address t vJ <br /> a x A z Notes <br /> City/state/ZIP 2L r �' '" c En i <br /> Phone I FAX Q '2p#1 _ � W W W m o <br /> Ili U <br /> o a ro 4 z ti <br /> Pro) # E3 a 0. �, 0 —4_L13-Q <br /> fieport Attention J E n r <br /> Sampler Signature a $ m <br /> u � <br /> _ 41131 <br /> Printed , OBSERb <br /> r ! <br /> Lob IDS` SAMPLE ID DATE TIME D ESCRIPTIONILO CATION <br /> -4-113� <br /> -------41_-3.4--- <br /> ��` - <br /> _ 41116 <br /> �- _ <br /> S <br /> + _411.3 B <br /> ),too 41139 <br /> Total number or containers submitted to <br /> SI Ce Printed N Irk at 1 lme Compan Na the laboratory <br /> All <br /> Note special requests(e g quick <br /> Relinquished by turn times)must be cleared through <br /> Rereived by �✓ ' '� �� / it aulhonzed laboratory personnel <br /> Relinquished by , <br /> Received by C <br /> � r RESULTS DUE , <br /> Relinquished by * � VERBAL WRITTEN <br /> Received by V <br /> -\T J \� <br />
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