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ARCHIVED REPORTS XR0006187
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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1856
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3500 - Local Oversight Program
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PR0544589
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ARCHIVED REPORTS XR0006187
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Entry Properties
Last modified
6/21/2019 11:38:21 AM
Creation date
6/21/2019 9:49:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006187
RECORD_ID
PR0544589
PE
3528
FACILITY_ID
FA0001909
FACILITY_NAME
STOP N SHOP
STREET_NUMBER
1856
Direction
W
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
123-191-02
CURRENT_STATUS
02
SITE_LOCATION
1856 W COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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SJGOV\wng
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EHD - Public
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Advanced CHAIN OF CUSTODOECORD <br /> �-���4_ � � <br /> --- GeoEnvironmental, Inc. Date Page o� <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006 - Fax (209)467-1118 <br /> Client Project Manager <br /> � Tests Requiredc <br /> Phone Number <br /> (4 1 Cz <br /> Samplers (Signature) G� Invoice <br /> � F Q, AGI <br /> Project Name Client <br /> Sample Location Sample Type No of 4 `� <br /> Number Description Date Time Water Air Solid Conts � Notes <br /> Comp Grab <br /> k%'�C' Li X1 X X X <br /> it -- 17 <br /> quis e y ignat re) <br /> Received y (Signature) �— <br /> Date(Trme <br /> 7 J ��—cJ <br /> R quashed by (Signature) Received by (Signature) r-- DatalTrme <br /> j Dateffime <br /> nature rued b Mobilo Laboratory for field analysis (Signature) � ` <br /> Relinquished by (Signature) Received y rY Y � 9 <br /> Dispatched by (Signature) Date/Time Received for Laboratory Dateffirn " <br /> f .6�' <br /> Method of Shrpme Labo ori Nam <br /> �,Irz1 6 CL d1 <br /> Special Instructions I her authorize the performance of the above Indicated work <br />
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