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ARCHIVED REPORTS_XR0012039
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_XR0012039
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Entry Properties
Last modified
10/10/2020 11:01:44 PM
Creation date
7/9/2020 8:33:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012039
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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CANTLE ANALYTICAL LABORATORY ,20 -776�;, �� rti ;� < <� � � CHAIN OF CUSTODY <br /> tocatiorl 2333 Shuttle Drive Bldg 9061909 Atwater, CA 95301 Certlflcdta No 2079 " <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 9b301 PAGE-4--CIF—L— <br /> Phone (209) 384 2930 - Fax (209) 384-1507 1 <br /> ja ne•rl r10 �i"'# Method of shipment <br /> Customer Y���t�i��-4erQ C��_l _rll�i_�TY117 �• -t" 1ii11 s" l Oil <br /> +' <br /> Address AVQb 1JJli iNlyJlntl a CA a cir <br /> City/State/ZIP L ( m <br /> y uJ Notes a <br /> Phone 1 FAx —A 1-1 2 q— <br /> -- ' <br /> Prol # �:. "� -w <br /> I <br /> Report Attention' - UJ a v o ; <br /> Sampler Signature a g y m �- , <br /> 1 <br /> PFlllteCl 9 <br /> ;,- <br /> y.l 11` <br /> SAMPLE ID DATE TIMEt]ESGRipTIQNlLOCATION y OBSERb ! <br /> - J SIA i,lMVj 1A-11 313 1 <br /> 1 <br /> r'—'T' I r _ 4 to 3 4___--- <br /> �. 4,10 <br /> - —_ <br /> I \ V <br /> i � <br /> .ay m � � 135 <br /> e-�RTa W9W a 1 •y+'�-�Jy/ I <br /> AJI 30 <br /> 41139 <br /> r"ALL a� Yl� 1 <br /> . !Y 7f C <br /> jy IN i <br /> wB""N� k'" "' Total number of containers submitted to <br /> s0 r`,"'v the laboratory <br /> Relinquished by ( s Note All special requesls(e 9 quick <br /> Hacswed by `. -� � 4 �� S "� `[ turn times)must be cleared through <br /> authorized laboratory personnel <br /> Relinquished by <br /> Hacelved oyMal <br /> �eltngtur�t�eci <br /> by � � � t• RIrSIJLTfi SUE 11 <br /> Rac.aived by VERBAL WRITTEN <br /> r <br /> \J <br />
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