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ARCHIVED REPORTS_XR0012040
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_XR0012040
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Entry Properties
Last modified
10/10/2020 10:57:59 PM
Creation date
7/9/2020 8:34:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012040
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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�V <br /> CASTLtANALYTICAL LABORATORY r CH <br /> � � � l�� A N OF CUSTODY <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 <br /> Mailing Address 2333 Shuttle Drive, Atwater CA 95301 PAGE—LOF T <br /> Phone (209) 384-2930 Fax (209) 384-1507 <br /> Customer Ct'G REQUESTED ANALYSES Method of Shipment <br /> Address 937 j uj a a l <br /> CitylStatelZIP '-` o Z 1 86149 <br /> Phone / FAX 6 - Oa f I _ 9 N W �, P i <br /> Pro) # I P 0 # 1 _j � m tL° . -}.. 86150 <br /> Report Attention <br /> Sampler Signature <br /> E 6 <br /> g g r�, <br /> Printed v 86151 <br /> z <br /> Lab,ff]# f SAMPLE ID DATE TIME DESCRIPTIONILOCATION .� 86152 <br /> 111} I -1i 1 <br /> 23 <br /> Ito] 86160 - 86153 <br /> iOq5-3 yl 86181 86154 <br /> b t Y 86162 5 86155 <br /> y r7 <br /> o ` A- 86163 A- 86156 <br /> 01 U- - 86157 <br /> w � <br /> 13 ✓86158 <br /> �a��k- + 86159 <br /> Total number of containers submitted to <br /> Signature Printed Name Date `time Com arty Nome the laboratory <br /> Relinqu � Note All special requests e p q ( g quick <br /> Received by <br /> turn times)must be cleared through <br /> Relinquished by authorized laboratory personnel <br /> Received by <br /> Ratinqulshed by RESULTS DUE <br /> Received by t VERBAL ( WRITTEN <br />
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