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ARCHIVED REPORTS XR0012589
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 XR0012589
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Entry Properties
Last modified
6/20/2019 5:17:57 PM
Creation date
6/20/2019 3:59:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012589
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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' i l <br /> D TTRKATIONAL <br /> r,�.. <br /> CAN. REAUi=ST FAR ANA i:,-SIS Control No. 230005 <br /> PROJECT NAME C` k' / C! Control No.. <br /> `44 ' DTE SAMPLES SHIPPEDZ �1 <br /> PROJECT TdUMElER k�&~i.4 7 - <br /> d LAB DESTINATION 119 1��! A P I� t „ <br /> PROM CENTER NUMBER � I - LABORATORY CONTACF GYWk• �:i Win <br /> PROJECT MANAGER 1 ''� 1, rt can i'J+,1 fn <br /> SEND LAB REPORT TO �]- s <br /> BILLTIO <br /> k i tIS�S .r Gtc�f1GE�7 �fy � � <br /> DATE REPORT REQUIRED <br /> �� . . <br /> PURCHASE ORDER NO. PROJECT CONTACT �)e^ 1.4-C <br /> PROJECT CONTACT PHONE NO.C:(_S 202- 9JQO <br /> f <br /> Sample Na Sample Type Sample Volume Preservative g Program k! <br /> 5 r Requested Test'ri P { <br /> Special instructions <br /> n <br /> 5 - F'3 �arir C <br /> +. <br /> .. 0 W - t <br /> Q-T C <br /> TURNAROUND TIME REOUIRED: (Rush must be <br /> approved by the Laboratory Project Mar►�gec) OC LEVEL: (Levels!1 and II!subject to lurch <br /> � 1 ergo:project-specific requirements must be <br /> Normal i RusA (Subject to rush surcharge. submitted to lab before beginning work.) <br /> tl 171 Project specific <br /> POSSIBLE HAZARD IDENT[FICATION: (Please indicate it sample(s)are hazardous materials and/or suspected to contain high levels of hazardous substances.) <br /> Non-hazard Ek2mr"s Skin Irritant <br /> Highly Toxic _ Other <br /> DISPOSAL Please indicate d' P g ysis.Lab wi charge for packing,shipping,archive and disposal.) (srebse speeiryy <br /> ( �sposition of sample follo+rtin anal !! z <br /> Z. <br /> Return to Client Disposal by Lab Archive (indicate number of months.) � <br /> FOR LAB USE ONLY I �✓1 g/9 <br /> ` <br /> ft-m dby e� f - lLd. - Date/Time 9,,� �7:r <br /> WHITE Ori tosr } <br /> —ELLq Said - .. <br /> ccamparry samples 7, <br /> Mill I <br /> i = <br /> i <br /> J <br /> ��ti <br />
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