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ARCHIVED REPORTS_XR0011980
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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130
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3500 - Local Oversight Program
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PR0545892
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ARCHIVED REPORTS_XR0011980
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Entry Properties
Last modified
7/22/2020 2:57:45 PM
Creation date
7/22/2020 2:29:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011980
RECORD_ID
PR0545892
PE
3528
FACILITY_ID
FA0003601
FACILITY_NAME
ARCO STATION #826951*
STREET_NUMBER
130
Direction
S
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205-5561
APN
15502064
CURRENT_STATUS
02
SITE_LOCATION
130 S WILSON WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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LSauers
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EHD - Public
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s F Q V OU ANALYTICAL SAIMLE CES'L LOC <br /> yy 4 <br /> 7 �. 14� - } <br /> CLU-NI NAME: ��..�i'I.�J DATE Rec ived at Lab: Drinling water for <br /> PMC.BY(PRLNT) "� TM Recelved at Lab: regulatory purposes: YFS/6-0) <br /> WORKORD U LL is kd-l-- SLOG LN DATF,- Wastewrtcr for <br /> regulatory p rposm: YES1 <br /> CIRCLE TU APPROPRIATE RBSPONSL LAB COINTAMM SAWLE DATE RENXAXt�S' � <br /> SANTLlr # CLI 'T lD VATS SA1v LED COri-DinQ--j TC_ <br /> i <br /> I. Custody Seal(s) p:e=t/ - lis tti/ tf tY <br /> qj 2-7- <br /> 2.Chainnof-Custody f Absent'` 12, 96L <br /> 3. TMMC Rtports c r <br /> ` Pac Ug: Present/P s t <br /> { <br /> 4. Akbil !y iabi�I{Stir�� <br /> Present 1as t <br /> 5.Airbill#: <br /> 6. Sam le Labels: Ag2at f Absent k <br /> 7. swnple Ms: X.' d I Not"Gicted ` <br /> a�n-op-G�zstadv <br /> 8. Semple Gmdl iorr t/B okcn*I <br /> Lecldn * <br /> 9. )Does xa£orrnation vex <br /> aubtody reports,trarfic <br /> reports quad samgq <br /> lnbcls ee? Ye f N077 <br /> 10. Sample received within <br /> ? hold dme: Yes <br /> 11.Pxopor Preserve ves <br /> used: y /Nom <br /> 12. Tamp REC.at Lab: <br /> L�ucrap 4*{_2°C? f NO*" <br /> +(Accep'ctnx[agge for sau:pies mqui ring iha=l p:cs.) <br /> *",Fxcejrtion(if uy):Mania I DFF or%icc?I Dn no ice? <br /> or Problem COC <br /> . - If Circled.contgci Pr2ject Manager and attach record of resnlutian. <br /> ` Sample Reoeip:Lag <br /> Revi3ior%3.3(12123402) i <br /> o Replaces RaVmkn ii (04111102) Ragt? 0 <br /> €ffectN81224M2 <br /> G , <br /> i <br />
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