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ARCHIVED REPORTS XR0006117
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 XR0006117
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Entry Properties
Last modified
6/21/2019 1:21:41 PM
Creation date
6/21/2019 10:45:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006117
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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2795 2nd Street, Suite 300 <br /> .�� Davis,CA 95616 <br /> Lab: 530.297.4800 <br /> ANALY77CAL cLc Fax: 530.297.4808 Lab NoA/ 3 'V _7 Page_ 2of 4 <br /> Project Contact(Hardcopy or PDF)�o : California EDF Report? ❑ Yes Chain-of-Custody Record and Analysis Request � <br /> Company/Address: ( ~ �,^� PW0MVw&d butr+ot Mgnoggy lo cmvbbftsecdon: <br /> Sampling Company Log Code: <br /> AQ <br /> nalysis Request <br /> Phone No., FAX No.: Global ll]: o x <br /> 0 CAL4 <br /> m m <br /> Project Number: P.O.No: EDF Dellverable (Emal dress): S In o <br /> Q ° o W m X p <br /> Project Name: S� C/t e Z sampler ignalure: $ m m <br /> UJ <br /> _ <br /> Proj�t�ddfess' _ o a <br /> 0O (� �G�� Sampling Cont finer P e ative atrix n Q N q v n -CIO <br /> /� ¢ w = Cl in m C c o N t U. <br /> C�G. 4i �U4 - > � � � w w � � N b � wr w � � <br /> E w O z ¢ J = x X x m Q a m <br /> 1 U z U O O r a e 0. D O O O m <br /> Sample Designation Date Time v0 22 wz s _ z m m r r r w > -r r <br /> ft <br /> 31 1 02- <br /> �a //z 3 � 3 <br /> Relinquished bl..G lite Time Received by: Remarks: <br /> rS{3 �r <br /> Relinquished Dae Time Received by: <br /> Relin Uished by- Date Time Received by Laboratwy: Bill to: <br /> 425 'Dr <br /> Distribution: White-Lab, Pink-Originator Forms/cm iMOI.th9 <br />
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