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ARCHIVED REPORTS XR0006109
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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1876
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2900 - Site Mitigation Program
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PR0542421
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ARCHIVED REPORTS XR0006109
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Entry Properties
Last modified
6/21/2019 12:55:13 PM
Creation date
6/21/2019 10:35:52 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006109
RECORD_ID
PR0542421
PE
2950
FACILITY_ID
FA0024377
FACILITY_NAME
COUNTRY CLUB BLVD/295950
STREET_NUMBER
1876
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12319101
CURRENT_STATUS
01
SITE_LOCATION
1876 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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i <br /> 2795 2nd Street, Suite 300 <br /> /FF Davis,CA 95616 <br /> Lab 530 297 4800 <br /> ` ANALYTICAL LLc Fax 530 297 4808 Lab No P ge of <br /> ` Project Contact Hardcopy or PDF To) CallforDla EDF Report? ❑ Yes No <br /> Chain-of-Custody Record and Analysis Request <br /> Company7Address Reaxmr xledlxetnotmadatm to i tetimsecom <br /> 6V S� r77 Sampling Company Log Code Analysis Request Q <br /> H <br /> Phone No FAX FAX No Global ID m x <br /> 5.P c6 S�UG s3o Cbz 0273 - o N L <br /> LU <br /> Protect Number PO No EDF Deliverable To(Email Address) ° ? m o a, <br /> '5vJ?e X 6 6 W N X <br /> Project Name ) Sam Sr ur o in in a m <br /> XLNc�iC2- Gom Z m C4 0 c p d <br /> m <br /> Protect Address — a a N .. — <br /> Sampling ontamer Preservative Matrix in o t V) N 3 <br /> H H U. p N Q <br /> W o � d O CO ,.. CO r L <br /> a O Ny c C C C G b N L 1L <br /> > > M W W J m m C7 m t7o eS m m C w <br /> E - L <br /> Sample Designation Date Time v ai i z 0 z � ° � 1 ti ti � PI- ° � J W � O r <br /> SPC Y I <br /> F-� 4�,-7 pe <br /> 1° Or- <br /> 51° -- 1312 VA <br /> 510 -,L oe <br /> Relrnqui d b Date Time Received by Remarks <br /> Resin ished by Date Time Received bv Ji3,WAk l//"��r,)45 ,6 A (, <br /> Comsr r' a•�c /�r3s� Cin y�5 , <br /> RelinquishElate Time Received by Laboratory �1- Bill to <br /> OHO �f �-��i7- ell <br /> Drstnbutron Whyte-Lab, Yellow-File,Rnk-Onginator Formslcoc 121001 M <br />
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