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ARCHIVED REPORTS XR0012481
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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CAMBRIDGE
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16470
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3500 - Local Oversight Program
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PR0544155
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ARCHIVED REPORTS XR0012481
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Entry Properties
Last modified
2/15/2019 6:17:47 PM
Creation date
2/15/2019 2:33:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012481
RECORD_ID
PR0544155
PE
3526
FACILITY_ID
FA0000185
FACILITY_NAME
CITY GAS & LIQUOR
STREET_NUMBER
16470
STREET_NAME
CAMBRIDGE
STREET_TYPE
ST
City
LATHROP
Zip
95330
APN
19643032
CURRENT_STATUS
02
SITE_LOCATION
16470 CAMBRIDGE ST
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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u Yes <br /> Fax co of Lab Report and COC to Chevron Cont ❑ No Chain—of r-CuStod cord <br /> + � Chevron Contact (Hama) <br /> Chevron Facility Number { <br /> Faculty Addres Y� �^ (Phone) <br /> Chevron Products Co. C; >y � <br /> P a� ���4 Consultant Project Number yam_ t — Laboratory Name. <br /> Consultant Name laboratory Service Order <br /> San Ramon, CA 94583 �a� •l�r� � Caratory Sam°. Code Z Z <br /> 4- <br /> FAX (925)842-837 Addre9s� <br /> Project Contact (Name) Samples Collected y Nam <br /> f� (Phone) ��- Fax Number} Signature <br /> State Method' ❑ CA ❑ OR Cl WA C1 NW Series ❑ " iO ❑ tJ Remarks <br /> H <br /> 4 <br /> It ` C N <br /> 'u 4 CL <br /> a(0 vw ° °' e o a b �� <br /> v rn n z <br /> E ` ++ aro <br /> a E + m.. c.. �.. .. o.. .-, <br /> +o �� � <br /> mg <br /> .. w <br /> z c� ^�� � lab Sample No <br /> U-1 f <br /> Rohn ad lay nature) rganixotl°n Dot /Ti no Received By (Signature) Or aniz°tion Da C�Tu'rn Around Time (Circle Choice) <br /> 24 Hire <br /> ReFingcushed Signature} otion 0 ta/Time r cnixatton Data/Time Iced Y/M <br /> �+ S 0cya <br /> / 7 1�'rTy 10 Days <br /> a.rneit^shed 9r Manotura� arpan+�at9n Oate,q me. Recieved For Lab°retary py (S+pia ur�)� Date/lime IcI4 YIN 7/ dated <br />
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