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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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`x.nits <br /> { <br /> ' II <br /> INTERNATIONAL 1 a y 5 7 8 <br /> TECE NOLOGY RIA Control No. <br /> CORNORATION REQUEST FOR ANALYSIS <br /> CIC Control No. <br /> PRi7JECT A#IlE' SY-5fugiD 0 DATE SAMPLES SHIPPED <br /> PROJECT NUMBER �g D�o'�Z , .,, ._. LAB DESTINATION <br /> pie(![r ;(Vi <br /> PROFIT CEWMFI NUMBER 3� I LABORATORY CONTACT _�A t�t -Chow <br /> PROJECT MANAGER DA til Wyh)N SEND LAB REPORT TO DAN W YMAJ -1T Cl P <br /> BILLTO 1_1_ CDRP 4•S9 q_IPA CQ aL-V P v <br /> 45,65 PAS1•fir'_"l_•e) I LVD T t N C CA- qI-;S <br /> �^4RT11ME7- r LA 9 1 DATE REPORT REQUIRED 1 10 D�'`t -FURIIIAROW-7(> <br /> PURCHASE ORDER NO. --- - PROJECT CONTACT DAN W VWN <br /> 'll <br /> PROJECT CONTACT PHONE NO. 1 t$d 0 7-1-- 2 �o <br /> Sample No. Sample Type San !a%"Ume Preservative Requested Testing Program Special Instructions jfa <br /> a <br /> x YGS; Cool . <br /> 555 e,.I IL_— r 95 i_ Coe(. <br /> p <br /> ml <br /> SSS M <br /> SSS-P4-3 SO 1 IAC .�� b �,� .sss v t_ o 0 e et PIC, T3.� S <br /> ,TSS-P4 _. <br /> TURNAROUND TIME REQUIRED: ' <br /> (Rush must be approved by the Laboratorf?roucl Manager.) QC LEVEL: (Levels II and III subject to surcharge;project-specific requirements must be <br /> rj submitted to lab before boginning work.) <br /> Normal Rush r. {Su�ject to s�rchall 1 11 Ilf Project Specific__ I <br /> POSSIBLE HAZARD IDENTIFICATION: (Please indicate if samples)are hazardous materials and/or suspected to contain high levels of hazardous substances.) <br /> Ir <br /> Non4azard Flammable Skin Irritant Highly ToxIc Other �. <br /> (Plei<se Specify) <br /> SAMPLE DISPOSAL: (Pkaso indicate disposition of sample following anl lab will charge for packing,shipping,archive and disposal.) <br /> Return to[dent Cbpoaal by Lab, y Archive (indicate number of months.) <br /> .f <br /> r ! y <br /> FORLAB USEONLY f ,r., 7 �•� � i .I •. ,'� <br /> j Received by �:, <br /> -�� Date/Time <br /> WHITE-OBy t.to Ples <br /> accompany sarn <br /> • <br /> I_: 'YELL[.,.. reld{ <br />
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