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3500 - Local Oversight Program
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PR0545347
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Last modified
2/6/2020 3:55:53 PM
Creation date
2/6/2020 3:15:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545347
PE
3528
FACILITY_ID
FA0003685
FACILITY_NAME
DBA CIRCLEK, REFUEL PETROLEUM INC.
STREET_NUMBER
419
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21938610
CURRENT_STATUS
02
SITE_LOCATION
419 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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Condor Earth Technologies, Inc. <br /> CHAIN-OF-CUSTODY ' <br /> ❑ 21663 Brian Lane 188 Frank West Circle, Suite I - <br /> P.O.Box 3905/Sonora,California 95370 Stockton, CA 95206 <br /> N° 5976 209-532-0361 209-234-0518 <br /> 209-532-0773 (fax) 209-234-0538 (fax) <br /> info@condorearth.com(e-mail) condor@condorstockton.com(e-mail) <br /> SHIPPED TO: SEND RESULTS TO: <br /> Rr�-oA/ �.F; bRA7o. � NAME: a.111.�j Wood <br /> 30 % �r't-� ��T,eF--�7' OFFICE: tadde),r) <br /> PLEASE FAX RESULTS: PROJECT: 1 <br /> r <br /> PROJECT N0. � S. u' ' ✓ Verification <br /> NO. v�cti <br /> SAMPLED of <br /> (Signature) con- <br /> (-.. twin- Q' <br /> Date Time Sample ID ers ,*' REMARKS: MISC. <br /> bf int <br /> d <br /> RelinquishW-9 �� Date: Time: Received By: Da Tinj_e: <br /> (Signature) s ' <br /> �f N (Signature) <br /> Relinquished By: Date: Time: Received By: Da e: Timeh- ' <br /> (Signature) (Signature) <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> (Signature) (Signature) <br /> Original-Send Yellow-File Pink-Log Book <br />
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