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ARCHIVED REPORTS_XR0011437
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_XR0011437
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Entry Properties
Last modified
1/13/2020 5:24:04 PM
Creation date
1/13/2020 4:18:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011437
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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Ir <br /> CASTLE ANALYTICAL LABORATORY a � ,�� �,, � - oL L CHAIN OF CUSTODY <br /> Location: 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 Certificate 14o. 2079 r <br /> Mailing Address: 2333 Shuttle Drive, Atwater, CA 95301 PAGE / OF f <br /> Phone: (209) 364-2930 - Fax: (209) 384-1507 <br /> Customer: uMethod of Shipment: <br /> Address: { yallseyl wiwa <br /> 12 <br /> Civ✓ r r �t <br /> City/State/ZIP: CA °'� � o `6 z Notes: <br /> Phone 1 FAX: — - 00 la W W 0 m 0 <br /> z <br /> Proi # - 1 a Q + U <br /> Report Attention: a <br /> Sampler Signature. ' a 8 m <br /> Printed: u z <br /> lett 115# SAMPLE ID DATE TIME DESCRIPTIONILOCATION OBSERVATIONS/REMARKS <br /> 15 9 cu -GI <br /> ; 2 a 3889 s <br /> t <br /> 3 "s q3Q 38897 <br /> I <br /> 38898 <br /> _P <br /> k <br /> I <br /> 4 <br /> E1BtUr8 } �i X Total number of containers submitted to <br /> s e rfi1p�11 *Jst tory <br /> t b <br /> �Iltt#CIf Ir1t :a ,�'[m { , the labors <br /> Relinquished by: l _asQ Note:All specie!requests(e.g.quick <br /> Received by: <br /> tum times)must be cleared through <br /> +S <br /> authorized laboratory personnel. <br /> Relinquished y: <br /> Received by: <br /> Relinquished 6y: RESULTS DUE: <br /> Received by: f F r r�7l+Y*{�rl :I;::�I, ` VERBAL YV rrFrEN <br /> 11-LAU�i�fYv hlliJ id)," Cj y;�lll ti C j� , <br />
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