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ARCHIVED REPORTS_XR0004432
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004432
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Last modified
2/6/2020 5:09:55 PM
Creation date
2/6/2020 3:39:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004432
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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SJGOV\wng
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EHD - Public
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Condo4pEarth Technologies, Inc. <br /> CHAT -01''-CUSTOD 1 ❑ 21663 Brian Lane 188 Frank West Circle, Suite I I <br /> P.O. Box 3905 1 Sonora,California 95370 Stockton, CA 95206 1 <br /> N° 5753 209-532-0361 209-234-0518 <br /> 209-532-0773 (fax) 209-234-0538 (fax) <br /> J f info@condorearth.com(e-mail) condor@condorstockton.com(e-mail) <br /> SHIPPED TO: SEND RESULTS TO: <br /> s NAME: Lee ,Kiss <br /> + iters . C OFFICE: c 1C � <br /> ❑ PLEASE FAX RESULTS: PROJECT: <br /> PROJECT NO. f <br /> NO. �S�S. J Verification <br /> SAMPLED BY: _ of v <br /> � <br /> (Signature) con- <br /> tain-tvt� �✓e//s tain- Q� R 11 <br /> U <br /> Date Time Sample ID ers REMARKS: MISC. <br /> t CPS 37 V - : 2t 0 ry <br /> <> E)` W _ 31 J03 ! fi <br /> iQI� .7.1741- 1qW 6` ' _7 2) <br /> X 791 � /fW-n ./ � p <br /> �7 vr <br /> i 3 311- Gl <br /> Relinquished By: I Date: Time: Received By: D te: Time: <br /> (Signature) /G + �G�f.:� `d[ (Signature) Z t S_ , <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> (Signature) (Signature) <br /> Relinquished By: Date: Time: Received By: Date: Time: <br /> (Si nature) (Signature) <br /> IOriginal-Send Yellow-File Pink-Log Book <br />
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