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ARCHIVED REPORTS_XR0005257
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545495
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ARCHIVED REPORTS_XR0005257
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Entry Properties
Last modified
3/10/2020 6:41:35 PM
Creation date
3/10/2020 4:32:15 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005257
RECORD_ID
PR0545495
PE
3528
FACILITY_ID
FA0006423
FACILITY_NAME
STOCKTON MOBIL 2
STREET_NUMBER
3440
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
3440 E MAIN ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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A <br /> CON <br /> 4 CHAIN OF CUSTODY REPORT <br /> Sample <br /> Dm No.L <br /> Beon Station on No. Sa le rirt Name) _aLIFof <br /> ,ANALYSES <br /> 2 <br /> p No, SampleI:ignMre) <br /> q7y) <br /> 1/1 1-f 3 <br /> L t\ <br /> projq Unation Affiliation - <br /> 9 OL/c /OOJ <br /> 1404,7 .-V.J rtiL) tN Crp <br /> —. <br /> 1 1 <br /> rDate Time Lab No. z° REMARKS <br /> S NoJldentffication <br /> t -`I� �Z6 -Mwiv 6 -Z6-00 ;30 131 <br /> 0G2 c - tL^U-, 12 1� 3 <br /> hI III I hi <br /> a <br /> vw 6 <br /> fi <br /> R <br /> ' n urelAffilia' n Date Time Received by:(Signature/Affiliation) Date Time <br /> Re1i ed by:(S�g at ) <br /> Relirtquis ed by:(Sigrtature/Affiliation) �. Date Time Received by:(Signature/Affiliation) Date Time <br /> Date Time <br /> Relinquished by:(Signature/Affitiation) Date Time Received by: (Signature/Affiliation) <br /> Report.To: Bili to: ULTRAMAR INC. <br /> ;. 525 West Third Street <br /> -- f Hanford,CA 93230 n <br /> Attention: k324M M <br /> WHITE: Return to Client with Report YELLOW:Laboratory Copy PINK.Originator Copy <br />
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