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ARCHIVED REPORTS_XR0007425
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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6131
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3500 - Local Oversight Program
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PR0545003
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ARCHIVED REPORTS_XR0007425
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Entry Properties
Last modified
11/27/2019 11:40:14 AM
Creation date
11/27/2019 11:23:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007425
RECORD_ID
PR0545003
PE
3526
FACILITY_ID
FA0002324
FACILITY_NAME
Pacific Service Station
STREET_NUMBER
6131
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09746418
CURRENT_STATUS
02
SITE_LOCATION
6131 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Da18 <br /> RETAIL ENVIRONMENTAL ENGINEERING -WEST Serial No Page al <br /> site�°!dares Analysis Required LAB <br /> WIC# --------- - -- - - - - -- - --- --- - - ---- -= <br /> — <br /> CFIECK ONE(l)Bol(ONLY CTIOT TURN AROt1NO TIME <br /> z U r.i - 7 5- <br /> - 0 W MAanlia,Ing ❑ 4481 --- <br /> Shell Engineer _ Phone No 24 hours U <br /> //�,' <br /> Site Investlgallon � 1441 <br /> 'Te lJ l�1 rr' Fax# <br /> SoY ClaselfrlDlaposal ❑ 1442 46 hour ❑ <br /> Consullanl Name Address d�G ~�`1 N <br /> � l C) Wafer 154ays (Normal) <br /> G/ �G..��l 5� �6� _ X Classify/Disposal I-3 4443 <br /> Consultant Conlaell ` Phone Nb til G X Other ❑ <br /> SoVAlr Rom at Sys <br /> Fax # 7 1 i -7�1 �o � N o a s� y ❑ 1452 <br /> ---- _ ---=—___f 00 NOTE Notify Lab as <br /> Commenis 0 a Q to Water Ram at Syssoon as possible of <br /> D D o a. Ee 1[4 0 b a AI I� 4159 24!40(us TAT <br /> _ co <br /> M M C) Other (_i <br /> Sampled by ------- tnin o c� h ---- <br /> " ? CD <br /> o CO a c r UST AGENCY <br /> n 0 c <br /> Printed Name /':�, , /u��r ��_ -- aa. d w 0 � its N m ° � -- -- <br /> --- - -- -- ---- u► w_ - m n r ° e '" SAMPLE <br /> XMATERIAL <br /> Sample ID pate Sludge Sod Water Air No °t x `-° 0 E E DESCRIPTION <br /> CONDITION( <br /> conllJs m j M (3 o COMMENTS <br /> ----r---- — - -- --_-*- - — - — <br /> Irl — - — -x — X -- - - - -- - -- — ------ 1 �� <br /> V- <br /> --' wo a_— <br /> - r -u c Pitz Skn p�!� hi0 it1 <br /> _ X •� w�<1 �i �5 r� _ _ I �� f <br /> Retinqu ed 0v(.s,�l furyy� Prin ed Na a Q )"71 <br /> ale� oc ve Ig re) /�.� Pr to Name `�— date �� <br /> on"YS�'r.>,_ L - -SE� - Tlme 1 - ----- - �/e/ Tima <br /> R(raq ish y�sl salute} Pr�nte Name (tale J awed( azure) Printed Name Dale — <br /> ` G --- - Tlme �� G _ _ _ _ __ __ Time <br /> 11' quished {signature) Primed arse pale _ Receive I ignature) — Printed Name <br /> — Dala <br /> J TI11 a -- ��iIAWCO <br /> - _ . L' Time /THE IABOITATOi�Y MUST PRQV)DE ACOPY OETlti USTODY WITH VOICE AND RESULTS s•� <br /> I H IN N <br /> REV 411/93 -- - ----------------- — srlri I rul f raiz-nrry r'Irnlh1 nf ri hTnnv <br />
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