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ARCHIVED REPORTS_XR0003247
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545289
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ARCHIVED REPORTS_XR0003247
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Entry Properties
Last modified
2/11/2020 9:56:11 AM
Creation date
2/11/2020 8:38:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003247
RECORD_ID
PR0545289
PE
3528
FACILITY_ID
FA0003828
FACILITY_NAME
VAN BUSKIRK GOLF COURSE
STREET_NUMBER
1740
STREET_NAME
HOUSTON
STREET_TYPE
AVE
City
STOCKTON
Zip
95206
APN
16307036
CURRENT_STATUS
02
SITE_LOCATION
1740 HOUSTON AVE
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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THE TWINING LABO�ORIES,:.INC. Pi��8- <br /> 2527 Fresno Street, F , CA 93721 Address <br /> (209) 268-7 21" AA <br /> Chain-of-Custody.and Analysis Request Record Mgr. TL# IFf m„7t <br /> Date--f •� . <br /> page of, Copies To: <br /> Armlysis Requested <br /> Report To: <br /> Ub Due Date <br /> .Client Name Bill To: <br /> Address ! <br /> Contact NameTQbJ4_�&kL406 Jam_ Expected Turnaround: T <br /> Phone 3 - OUTINE CRUSH VERBALS* ❑RUSH REPORT` i <br /> Conti PO# / *—Additional Fees Apply . 0/ (/� f <br /> Sampler Name--- irt-_L. �*cEr- ,_ <br /> Specify Date: _ If /. 10 <br /> 1r ❑FAX# <br /> . .E Client 5ampfa Sample <br /> Sample ID Date/time T eJSizeAtlft �n�� <^ 1 ling ” <br /> yp ,� Preservation Hand`" tion <br /> Gam :. <br /> gggdf �€ BEN <br /> Y <br /> G <br /> •F - ., � ", -... � ,�'pec -£ ��� e <br /> • <br /> 171 <br /> kA <br /> rj <br /> Each..hazardous-sam le submitted For Water samples, please Comments: d ��[?ate <br /> p °1 h /Time Locatioh <br /> far analysis will be charged a hazard check one of the following: r "° <br /> bis.waste disposal-fee. Clients that Drinking Water ^ y <br /> Weve hazardous samples within-30. 0 Waste Water <br /> days of the analytical report date,wili In Ground Water(wells) <br /> be refunded iWdisposal fees. ❑Surface Water(rivers,lakes) � ' ' . ¢ <br /> 1 -1Il1qu(shed 8y Delivered By: e � <br /> 99? <br /> S1 nature Signature <br /> an - <br /> 1 <br /> #ttedPrinted ; <br /> a <br /> .CoAlPany T�Of- <br /> Company j1�' t e <br /> ZI <br /> Date/Time <br /> i <br /> RF <br /> y1,Yftj`- <br /> r.Fw� <br /> SHADED AREAS FOR OFFICE USE ONLY <br />
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