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ARCHIVED REPORTS_XR0011430
Environmental Health - Public
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EHD Program Facility Records by Street Name
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F
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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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ARCHIVED REPORTS_XR0011430
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Entry Properties
Last modified
1/13/2020 5:30:54 PM
Creation date
1/13/2020 4:16:06 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011430
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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Advanced CHAIN OF CUSTODRECORD <br /> j <br /> GeoEnvironmental, Inc. Date dz- Page ( of� <br /> 637 Shaw Road-Stockton, California-95215- (209)467-1006 - Fax (209) 467-1118 <br /> Client Pro'ect Ma er <br /> Tests Required <br /> ep <br /> one umber " <br /> i <br /> 7rs: Signature) Invoice: <br /> Project Name AGE <br /> (9�C—U-41- ys x <br /> Client ❑ <br /> Sample Type <br /> Sample Location No. of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> I Camp. Grab. <br /> 01Z/a 31-9 2-0 2- <br /> i rA:2- 2 0� - v✓ <br /> i <br /> 3 /3q'2 — vv <br /> ►� a �« !�5XX X qVV <br /> Ri Vinish a y: i atureReceived y: (SignatureDa elFime / <br /> ' <br /> Relinquished by: (Signature)V Received by: (Signature) 16aletTIMS <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Date/Time <br /> Dispatched by: (Signature) Date/Time Aeceivad for Laboratory by: Date/Time <br /> Method of Shipment: 0Lab r ory Nam f <br /> Ute <br /> Special Instructions: I her authoriz performance of the above indicated Work. j <br />
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