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ARCHIVED REPORTS XR0012491
Environmental Health - Public
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EHD Program Facility Records by Street Name
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D
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DR MARTIN LUTHER KING JR
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620
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3500 - Local Oversight Program
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PR0544216
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ARCHIVED REPORTS XR0012491
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Entry Properties
Last modified
3/4/2019 11:00:15 PM
Creation date
3/4/2019 3:49:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012491
RECORD_ID
PR0544216
PE
3528
FACILITY_ID
FA0003738
FACILITY_NAME
CHARTER WAY SHELL*
STREET_NUMBER
620
Direction
W
STREET_NAME
DR MARTIN LUTHER KING JR
STREET_TYPE
BLVD
City
Stockton
Zip
95206
APN
16504007
CURRENT_STATUS
02
SITE_LOCATION
620 W DR MARTIN LUTHER KING JR BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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dI IVL�. VIL t;(-)MPANY CHAIN OF CUSTODY RECORD Fj Dale: 2 - -� <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Sosial No: 2 - A PagO z o! -� <br /> Q Addross: 620 W. Analysis Required LAB: vbc- <br /> Charter day„ Stocktotri CA � <br /> C 204-7524-4305 <br /> ClacX OHt;l5)IOX OHIy CiJCL Will Alkoulio""t <br /> CeW WACI OM 11 Ix� 4 II =1 noun ❑ <br /> oil fnc�{noer; Phon© No : (510} <br /> Alex Perez 67J-6168 Sf.Lnv.tlSpoloA ❑ 4"1 <br /> NN Fax f• 675-6172 91 `I"°�" ❑ <br /> nsullnaenTam& AVd�eSs.Inc. lot CIO"vy/Dlapoaat ❑ 4u7bla-L ❑ <br /> 1680 Rogers Ave. , San .lose, CA 9511.2 x ` llaayr lLt4arrwrl <br /> was.: I <br /> CLaraYy/S71+poa" ❑ 4") Orn., ❑ <br /> Dmullanl Contact. Phone No • (408) <br /> Fran Thie 573-0555 9: w as of/ a.�o►syr ❑ uS1 <br /> Fax 3-7771 o d u, �� Hon, HaturLoh ca <br /> Wd.r Item of Sys soon as roaalplu of <br /> ommonts: v 1 0 o j M ❑ uS3 24/41 him fAr <br /> 0 <br /> C) <br /> g -- u 6 00. Z other ❑ <br /> ampt©d by: at � � chi o a a m � y � <br /> $ 0 � rn a. a I` 6 o UST AGENCY: <br /> m)lod Name- ,&L Gl:.vr"'�` l � W a o c o �M <br /> �- ° a v a a. MATERIAL. SAMPLE <br /> x T E LL I; CONDITION/ <br /> Sample ID Dalo Sludgo Soll Wolor Air No n( a 4 o o n o �' o DESCRIPTION <br /> cones m > U Q U p. U �1 COMMENTS <br /> kx <br /> �' <br /> inqulshq By( gnaluro), Prinlad Noma. Dula Roco vad Islprtalur Pr ad-Npma }t Dala �. <br /> lfi•� <br /> 1ingUihcd By (slgnaluf ) Prinlod Noma Dalo a Recolvod(slarffituraY Hated Noma �4 Dale, <br /> limo n I nme <br /> �Ilnqulshod By(slonaluro) Prinlod Hamo Dols ROCOIvod(signaluto) Prinied Noma- Dnle- <br /> Timo- <br /> 4F A COPy OF nits 1)(WIT IN gdl:- NQ BE5ULis -- <br />
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