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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0528915
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COMPLIANCE INFO
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Last modified
2/20/2020 5:09:01 PM
Creation date
2/20/2020 1:44:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0528915
PE
2950
FACILITY_ID
FA0019374
FACILITY_NAME
WALGREENS DRUG STORE
STREET_NUMBER
15
Direction
W
STREET_NAME
HARDING
STREET_TYPE
WAY
City
STOCKTON
Zip
95204
APN
12707026
CURRENT_STATUS
01
SITE_LOCATION
15 W HARDING WAY
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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WATCoL— 0 F 1 ( &)2 <br /> CHAIN OF CUSTODY �'� Vt Pay,e of <br /> Q , <br /> a <br /> Lab' <br /> TAT J�Gr^c�aY� <br /> Report results to: <br /> Name Project Information <br /> Company Bureau Veritas Project No yy�-':, 0. : zl- a 3 <br /> Mailing Address 6920 Koll Center Parkway, Ste 216 Name V.t..do;,�r�� S41n-c.# 01-t.10 <br /> City, State. Zip Pleasanton, California 94566 Location <br /> Telephone No (925)426-2600 <br /> Fax No (925)426-0106 Analyses Requested <br /> Errlail 0.�c�k.o_�,u��n r�.:�v�r,}�s• • <br /> cta��•o.stntor� QvS.b.X;!.�lVt/�1.6.s•�ew� <br /> Special instructions and�or specific regulatory requirements <br /> t <br /> 3 a� EDD Format for Geotracker <br /> c1 Yes No <br /> m <br /> ie <br /> Date Time Matrix/ No.of L Sample Condition/Comments N <br /> ` <br /> Sample Identification Sampled Sampled Media Conts a <br /> K <br /> >1 17A LFi 10 <br /> �L (31) - 11 C� C ,✓ ICER'- A PP C� TE <br /> HE D$ AC Aes NT --- C RESERVED 1N LA13- <br /> OAS O L G I METALS OTHER <br /> -H+ 1 I I I <br /> 1 <br /> Collected by: A4,T51> F;T4,1, til 'L JJ,)� Collector's Signature: , <br /> Relinquished by: Date/TimeIr f 1 S y'.`" Received by: X, l Date/Time <br /> Relinquished by. _ .! Date/Time ` ss °P rlJo Received by: Date/Time <br /> Method of Shipment: Sample Condition on Rcpt: <br />
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