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ARCHIVED REPORTS_XR0008579
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WATERLOO
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2537
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3500 - Local Oversight Program
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PR0545857
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ARCHIVED REPORTS_XR0008579
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Entry Properties
Last modified
10/10/2020 10:15:47 PM
Creation date
7/15/2020 3:02:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008579
RECORD_ID
PR0545857
PE
3528
FACILITY_ID
FA0005147
FACILITY_NAME
E-Z FOOD
STREET_NUMBER
2537
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95205
APN
11914035
CURRENT_STATUS
02
SITE_LOCATION
2537 WATERLOO RD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
Scanner
LSauers
Tags
EHD - Public
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i <br /> 46 a le <br /> K2795 F 2nd Street,Suite 300 <br /> Davis,CA 95616 <br /> Analytical LLc Lab 530 297 4800 SRG#/Lab No 4-77(P'�' Page � of <br /> Fax 530 297 4802 —^ <br /> Project Contact(Hardcopy or PDF To) California EDF Report ❑No <br /> —Jlvvk11 Chain-of-Custody Record and Analyses Request <br /> C mpany/Address Sampling Company Log Code <br /> ,�Y Analysis Request TAT <br /> Phone# Fax# Global ID o -- ❑ <br /> NAO 477- 7u t $3t'S" Ln 12 hr <br /> Project# P O # 0 m <br /> EDF Dellverabie To(Email Address) ❑ O <br /> DP1115-U9(0L rJ r41,3 { ri� 6v►'1 4 <br /> a I <br /> Project Name Sam p 5e Is o 24 hr <br /> Rpm- STCCt-:k1h1 � `a+ N <br /> IL Ln m m N 4 CO ❑ <br /> Pro)ect Address �1� Sampling Container Preservative Matrix ® m W < $ a o 48 hr o` <br /> LS37 + 1tx, 1'•a a ¢ a W w v UO <br /> m <br /> j-Rbc ►ar CA N � w N r� W 35 <br /> W F � <br /> W a a 72 hr <br /> lire J <br /> W X LU <br /> V, <br /> Sample Designation Bate Time g ti c g 3 F a s 3 1 rvk <br /> Y►'1w•� i 6s <br /> I <br /> Oz <br /> nnw-`I d3 <br /> 04 <br /> New-S <br /> 07 <br /> mw-7 <br /> j�►1w-9 <br /> lywo,3 <br /> Mw-1D <br /> Relinquished by Date Time Received by Remarks <br /> s ck N1 <br /> Relinquished by Date Time Received by <br /> Fill to <br /> Relinquished by Date Time Received by laboratory For Lab Use Only Sample Receipt <br /> Temp°C Initials Date Time I Therm tD# COOM Prmera <br /> n 1 0 OIazp 1 =A-4 <br /> es / No <br /> Dstnbulton White Lab Pink Originator <br /> Rey 051805 <br />
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