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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WILLOW GLEN
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13751
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2900 - Site Mitigation Program
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PR0009025
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Last modified
5/19/2021 2:51:15 PM
Creation date
5/19/2021 12:24:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0009025
PE
2960
FACILITY_ID
FA0004055
FACILITY_NAME
LATHROP GAS DEHYDRATOR
STREET_NUMBER
13751
Direction
S
STREET_NAME
WILLOW GLEN
STREET_TYPE
RD
City
STOCKTON
Zip
95206
APN
19105010
CURRENT_STATUS
01
SITE_LOCATION
13751 S WILLOW GLEN RD
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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SJGOV\dsedra
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EHD - Public
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Ship To: [n/7/'-O/► 4L'4S <br /> CHAIN OF CUSTODY RECORD <br /> Pacific Gas & Electric Company 2,��°� <br /> 3400 Crow Canyon Road,San Ramon,California 94583 <br /> (510)820-2000 Attention: Phone: <br /> �1�r �ov,� SID- 3i-/788 Page ! of z <br /> Job Number: Proje`ctName: Project Manager: 0 <br /> t'o 7/43—Ri9-TQf1 Zl f!vRAP ��Y;Wrwt- <br /> Samplers: ignaturess)) Field Team Leader: <br /> ink <br /> SAMPLE SAMPLE <br /> NUMBER DATE TIME TYPE SAMPLE INFORMATION of d•a� � REMARKS <br /> CNTRS. <br /> (3-5-F7-) IVW?2- So I L I <br /> /V1W-1 (9 o FT) 1y�3�q Sot1, I ✓ CI-IRDMALAB F=I'L.E 1 <br /> C.lf7DEFt If <br /> Cd \ U <br /> 00 E Z !! 3 r/-7 11t Sots I / ✓ ✓ <br /> B-Z (8.S F7) " u1 ScilL I ✓ ✓ <br /> t3-3 3.0 F7-) )y <br /> F2�z SotC I ✓ J <br /> 7 S G"7� I <br /> B-s �s F•) I - <br /> B-� (3.° Fr) I <br /> -� (7.sFr) j <br /> 1-7 (3,o Fr) I <br /> Relinqui d By:(Signature) Date)Time: Received By:(Signature) DaleTme: n�.y� Ship Via: <br /> S /VZ_S_19Z?,/Zoo I/ yS9z <br /> Relinquished By:(Signature) DateTme: Received By:(Signature) Date/l-ime <br /> BVAirbill Number: Date: <br /> Relinquished By:(Signature) Date/Mme. Received By:(Signature) OateMme. <br /> DISTRIBUTION: Original Accompanies Shipment;Canary Copy to PG&E;Pink-Sampler NOTE: Samples are discarded 30 days after results are reported unless other arrangements are made. 60006997/GI/TI97 <br />
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