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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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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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i Eras f <br /> SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dal • i1 <br /> RETAIL ENVIRONMENTAL.ENGINEERING-WEST Serial No . <br /> � 273 <br /> 3��s. Page of ,- . <br /> CC' 5 r3 y,ti Analysis Required LAB; r <br /> wica: <br /> C"ECx ONG(q box ONLY CTRr TURN AROUNb TIMI: <br /> Shell Engineer: aw Iltonlialee ❑ 4461 <br /> J Phone No ❑ <br /> ✓ L�-� 1�� 8itr kwssilgaihm 1441 �4 hours <br /> �J Fax�. ❑ Ia hour. CI <br /> Consultant Name&Addre �I',�C, c ea Cla..al' 81 1447 <br /> 73922 water 15 day*'k(Narr 4 <br /> Co Clasagrmbpoaat ❑ 4117 Other ❑ <br /> nsu Cant on . Phone C o: 7/4 <br /> Z —Lit o _ 1.0 p Q m Fiero a Sys ❑ 1152 <br /> Comments- Id Fax#._7x96 7b382 ad NOTE1Fktyiabaa <br /> Q +r1 water Ron or By$ NOT w pony to w <br /> J157a coo 0 9 Irl ❑ W 6a 2U11 two TAT <br /> Sampled y' m >n N 3: aner ❑ <br /> I12 C N >- UST AGENCY: <br /> Printed Name-. 7a -C f o a l m a 1w <br /> y m ° MATERIAL SAMPLE <br /> t� <br /> Sample ID DOW sludge soft No oI x x U Erz <br /> CONDITION/ <br /> Water Air conte � � � � � � � B li 8 DESCRIPTION COMMENTS <br /> z - x <br /> Rel IThed (s ature) Printed Name Dale k1ved <br /> T 1 � prt a Nams Dale, <br /> yC p �iw. i. {�itJ1.��°T/ Time �t�{ r_l _ The.e qui (slpnatute) Pr I Name Dale ej Prinled Name. Date. <br /> quls y(signature) Printd Nam ay/ TimeDale, alure} Rinted ame Date <br /> Date <br /> Time0hA <br /> Time <br /> THI",LABORATORY MUST PROVIDE A COPY OF THIS CHAIN-OF- ST DY ITH INVOICE AND RESULTS <br /> REV VIM3 r <br /> rryy f,,. ►�•°'i• "� * 91 MU OIL COr.1PAW CHAIN OF CUSTODY <br />
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