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ARCHIVED REPORTS XR0011141
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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701
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3500 - Local Oversight Program
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PR0544217
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ARCHIVED REPORTS XR0011141
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Entry Properties
Last modified
3/4/2019 11:25:56 PM
Creation date
3/4/2019 4:36:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011141
RECORD_ID
PR0544217
PE
3526
FACILITY_ID
FA0002512
FACILITY_NAME
GSG GAS & MART
STREET_NUMBER
701
Direction
E
STREET_NAME
DR MARTIN LUTHER KING JR
STREET_TYPE
BLVD
City
STOCKTON
Zip
95206
APN
14734311
CURRENT_STATUS
02
SITE_LOCATION
701 E DR MARTIN LUTHER KING JR BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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WNg
Tags
EHD - Public
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Advanced CHAIN OF CUSTODY RECORD <br /> -_- j <br /> GeciEnvironmental, Inc. Z Date ZU ut Page of <br /> 4005 Norah Wilson Way-Stockton,California-95205-(209)467-1006 Fax(209)467-1118 <br /> Client ProjectManagetr J ty Tests Required <br /> 1 J L A) '"�'f k <br /> Phone Number <br /> Samplers (Signature) invoice <br /> 1, AAl�ii_1.j� � Lee '1� AGE <br /> Project Name + r' ,�' ' Client ❑ <br /> sample Location Sample Type No of y Notes <br /> Number Description Dale Time Water Air Solid Conts +L�' <br /> Comp Grab [,- <br /> 70397 <br /> d t '� X X Ix 1 70398 <br /> Lem <br /> >- <br /> 1,ti ©� 70399 <br /> I J <br /> e nquis e y rgnature eceive y ignature Date/Time <br /> Reimquished y ignature) Received by (Signature) f7atefrime <br /> Relinquished by (Signature) Received by Mobile Laboratory for flaid analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboratory Date/Tima <br /> laboratory Name <br /> Method of Shipment � C) I <br /> I hereby uth ize the performance of the above indicated work <br /> Special Instructions <br />
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