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ARCHIVED REPORTS XR0005965
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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2081
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3500 - Local Oversight Program
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PR0544590
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ARCHIVED REPORTS XR0005965
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Entry Properties
Last modified
6/21/2019 2:53:44 PM
Creation date
6/21/2019 11:09:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005965
RECORD_ID
PR0544590
PE
3528
FACILITY_ID
FA0003932
FACILITY_NAME
KWIKEE FOODS
STREET_NUMBER
2081
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12315225
CURRENT_STATUS
02
SITE_LOCATION
2081 COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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m 680 Chesa ..,ce Drive- Redwood 50,001A ANALYTICAL City, CA 94063 • (415)3649600 FAX{415} 3s4-9233 <br /> ❑ 819 !Nest Striker Ave. • Sacramento CA <br /> 95834 • (916) 921-9600 FAX (916) 921-0100 <br /> CHAIN OF CUSTODY Ch 1900 Bates Ave., Suite LM • Concord, CA 94520 - (510) 686-9600 FAX(510) 686-9689 <br /> Company Name: y -ul.�.iv�. �- :Project Name: �! t � :-L D`a <br /> Address: ,7.r Billing Address ( if different): <br /> City: ; ' U +L-�Y . State: Zip Code: 5 �. <br /> c <br /> Telephone: .�� �L -��LL FAX#: _S(,�� P.O.#: _m <br /> ' S,4,*-;" U <br /> Re rt To: U �W-��- ISampler: 10C Data: Level A(standards ❑ Level B ❑ Level C ❑ Level D_ _ c <br /> Tumaroun 10 Working Days ❑ 3 Working Days ❑ 2 -8 Hours ❑ Drinking Water Analyses Re uested <br /> Time: ❑ 7 Working Days ❑ 2 Working Days Q Waste Water <br /> ❑ 5 Working Days ❑ 24 Hours ❑ Other <br /> Client DateMme Matrix #of 7 Cont. Sequoia's <br /> Sample I.D. Sampled Desc. Cont. Type Sample# Comments <br /> 1. .0Q <br /> a� <br /> Cr <br /> 3. <br /> 4. <br /> w : <br /> 7. ���, 365 � / cc <br /> Cn <br /> 9. Kti -z <br /> Relinquished By: Date: Time:�./Izro Received By: Date: Time: <br /> Relinquished By: Date: Time: Received By: Date: ime: <br /> Relinquished By: Date: JEme. Received By Lab: atei ' t ime: y UC7 <br /> Were Samples Received in Good Condition?gYes 13 No Samples on Ice? WYes 0 No Method of Shipment E3"�� Page?-of <br />
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