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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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FREMONT
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4100
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3500 - Local Oversight Program
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PR0545177
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Last modified
1/13/2020 5:04:52 PM
Creation date
1/13/2020 4:03:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545177
PE
3528
FACILITY_ID
FA0002123
FACILITY_NAME
GREWALS GAS & LIQUOR*
STREET_NUMBER
4100
Direction
E
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95215
APN
14333046
CURRENT_STATUS
02
SITE_LOCATION
4100 E FREMONT ST
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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I Advanced CHAIN OF CUSTODYi <br /> Z RECORD <br /> Z -IF- <br /> GeoEnv ronmental,'Inc, Date- Page — a <br /> 837 Shaw Road.-.Stockton. California-95215-(209)467-1006, Fax (209)467-1118 <br /> Client 1 � ` Pro'eo anagen Tests Required "I <br /> P,Oone Num r <br /> 1 `-7' K <br /> i `/( Sam lers: (Sign e) //// Invoice: <br /> AdE <br /> Project Name li�( "f t / Client <br /> Sample Location Sample.Type f No.Of Notes Descri tion Date Time Water Solid ( % /J / <br /> p comp. crab. Air CDnts( <br /> lW.i / C j <br /> Lod <br /> LL <br /> '710 <br /> nq�is Y'( Receive y: (Signature) QatorT'me <br /> Relinquished by: (signature) " - Received by: (signature) Datelrime N <br /> O <br /> co <br /> Relinquished by: (Sig,naturel Received b Mobile Laboratd for held analysis;(Signature) Data `n <br /> .. Y Laboratory Y 9 1 � � ... !Time:. <br /> Dispatched by: (Signature) Date/Timo - Receive . 4a atony. Y: atefrime <br /> Method of Shipment: t ^ Laborr2&tme �r <br /> -Special Instructions: �!� .� I I he-rob uttroriie the part 'mance of the aboveindicated work. <br />
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