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ARCHIVED REPORTS XR0012588
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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1403
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2900 - Site Mitigation Program
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PR0505513
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ARCHIVED REPORTS XR0012588
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Entry Properties
Last modified
6/20/2019 5:05:37 PM
Creation date
6/20/2019 3:39:30 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012588
RECORD_ID
PR0505513
PE
2950
FACILITY_ID
FA0006438
FACILITY_NAME
United # 5446
STREET_NUMBER
1403
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12323246
CURRENT_STATUS
02
SITE_LOCATION
1403 W COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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INTERNATIONAL RIA Control No. =1 ~)j <br /> TECHNOLOGY CHAIN-OF-CUSTODY RECORD �- 7 <br /> CORPORATION C/C Control No. 7[17 n•� <br /> . 11 hNc,ms <br /> LAB DESTINATION <br /> PROJECT NAMF1NUMBER <br /> RIP r% LAB ! <br /> SAMPLE TEAM MEMBERS J ! — CARRIERIWAYBILL NO. <br /> Sample Sample Condition on Receipt Disposal <br /> Date and Time Sample Container Record No. <br /> Collected Type Type (Name t;N atal <br /> Number Location and Description <br /> 1 r <br /> `7S <br /> jq <br /> �S F 1'l/� � �L•�� �'-r' I r ��� i I �t a <br /> rAN � , � � ¢. <br /> i 3> <br /> 1 <br /> Special Instructions: 1 -- <br /> Possible Sample Hazards:— <br /> SIGNATURES: (Name,Com an Date a' Time) 21'h j d'- <br /> 1. Relinquished By: <br /> j 3. Relinquished By: h <br /> - �,r,r i <br /> Received By <br /> Received by: <br /> 2 Relinquished By: 4.' Relinquished By' <br /> , <br /> Received By: <br /> Received By: <br /> A <br /> {f_ ... i� <br /> Wr{}TE-To accompany sar', <br /> �. <br /> YELLOW-field copy ; g <br />
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