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ARCHIVED REPORTS_XR0004444
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004444
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Entry Properties
Last modified
2/6/2020 4:42:27 PM
Creation date
2/6/2020 3:46:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004444
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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Condc*Earth Technologies, Inc. 4 r <br /> CHAIN-OF-CUSTODY ❑ 2I663 Brian Lane ❑ 188 Frank West Circle, Suite <br /> P.O. Box 3905 /Sonora, California 95370 Stockton, CA 95206 `P <br /> N o 6 6 1 8 209-532-0361 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 /> r n�r�rV l l3 NAME: G ff A4 0 nsle- <br /> C 6712 r,=5 Gia . OFFICE: 5-7_6 cy 7-ioA/�_ C,4�___ <br /> ❑ PLEASE FAX RESULTS: PROJECT: zgz2 l X14 <br /> PROJECT NO. <br /> NO. 45��. Q V Verification <br /> SAMPLED B of �V <br /> con- <br /> (Signature) �� Lvaia, tain- Q� <br /> Date Time Sampl ID ers REMARKS : MISC. <br /> D _L22y - �f <br /> 4) D <br /> S Z <br /> zt <br /> q t <br /> Relinquishe B : D te: Time: j� Received By D e: Time: <br /> i na <br /> (Sture) o ` V (Signature) <br /> Relinquished By. D' e: Time: Received By: Date: Time: <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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