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ARCHIVED REPORTS XR0006403
Environmental Health - Public
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EHD Program Facility Records by Street Name
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P
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PACIFIC
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6425
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2900 - Site Mitigation Program
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PR0519189
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ARCHIVED REPORTS XR0006403
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Entry Properties
Last modified
8/21/2019 4:32:22 PM
Creation date
8/21/2019 2:35:00 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006403
RECORD_ID
PR0519189
PE
2950
FACILITY_ID
FA0014347
FACILITY_NAME
CURRENTLY VACANT
STREET_NUMBER
6425
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09741031
CURRENT_STATUS
02
SITE_LOCATION
6425 PACIFIC AVE
P_LOCATION
01
QC Status
Approved
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EHD - Public
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Reporting Intormalron T <br /> t. CGenl ) PROPCRTIi'S ftlJ7C1lt:Cll2 E1IY11"Ul?111C111Qll Y1rQ11r{ LI`1'! Pago_—A, <br /> Addie qg 3440 Vincent Road,Plcasant tlrll.C1t'rf4S23 <br /> Address 6 <br /> �46 8 P11011C(510)930-9090 REQUEST FOR ANALYSIS f CHAIN OF CUSTODY <br /> Contact. John 4"owski FAX(510)930.0256 Lab Job Number. ' <br /> AIL Contact•r Lab Destination: <br /> Data Samples Shipped <br /> Address Report To Send Invoice To- Lab Contact <br /> 2. Western Geo–Engineers 3. Dale Results Required <br /> Same As #1 Data Report Required- <br /> 1386 E. Beamer Street CtEanl Phone No. <br /> Woodland, CA 95776-5003 _ Client FAX No- <br /> Send Report To 1 or J) (Crrclo ono) ANALYSIS <br /> f� <br /> Client P 0 No• Cliont Project 1 D No !r 603 <br /> Sample Team Member(s) a2art1?t_C[l- , <br /> Dale/ No. Typo <br /> Lab Client Sample Air Time Sample pros. of of <br /> Number lndentrltcalion Volume Collected Type Cont Coni Comments 1 Hazards <br /> ,L .---� /(x '35 CL Zy <br /> rnu -�----- 9-'3.51 <br /> _mug-�33 _ //:OL 77- <br /> m i . _ /� v � - -- <br /> Inui '13 7- 7- <br /> In <br /> Relinquish ed by DATE TIM�„ r r1 Rocaivod by. DTE TIM7E <br /> (Signature) <br /> L-12- 9,7 (Slgnaturo) 6,(2 -f7 <br /> Rerwgwshed by DATE TIME Received by DATE TIME <br /> (Signature) (Signature) <br /> rlotinquishod by DATE TIME Rocolvod by DATC TIME <br /> (Signature) (Signature) <br /> Method of Shipment Lab Comments P I <br /> Y� <br /> 'Sample typo(Speedy) 1)37mm 0 0 pm MCEF 2)25mm 0 0 pm MCEF 3)25mm 0 4 pm polycarb liltor <br /> 4)PVC litter, dram pore slzo 5)Charcoal tubo 6)Silica got tube (Z)Walor 0)Soil 9)Bulk Sample 1 <br /> 10)Olhor 11)Other <br /> COPIES N OTE-JOG RE YELLOW,PIIOJECT FILE PINK•CLIENT s <br /> l <br />
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