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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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2900 - Site Mitigation Program
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PR0541800
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SITE INFORMATION AND CORRESPONDENCE
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Entry Properties
Last modified
3/16/2020 3:45:11 PM
Creation date
3/16/2020 2:01:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0541800
PE
2960
FACILITY_ID
FA0023969
FACILITY_NAME
CANCUN RESTAURANT
STREET_NUMBER
135
Direction
E
STREET_NAME
MINER
STREET_TYPE
AVE
City
STOCKTON
Zip
95205
APN
13908010
CURRENT_STATUS
01
SITE_LOCATION
135 E MINER AVE
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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® Advanced GeoEnvironmental, Inc. www.advgeoenv Com CHAIN OF CUSTODY RECORD <br /> 837 Shaw Road,Stockton,California 95215 •Phone(209)467-1006 • Fax(209)467-1118 <br /> 381 Thor Place,Brea,Califomia 92821 • Phone(714}529-0200• Fax(714)529-0203 Date: /N/y Page of <br /> ❑2318 Fourth Street,Santa Rosa.California 95404 •Phone(707)570-1418 •Fax(707)570-1461 <br /> ❑395 Del Monte Center,#111,Monterey,Califomia 93940 •Phone(800)51 I-9300 •Fax(831)394-5979 Analysis Required <br /> FProject Name <br /> J r�N f Projec tus er <br /> Client S� T Samp r(initials&algnah ) <br /> 1 <br /> Invoice to: AGE ❑ Client Lab Project <br /> Sample ID/Location/Description Date Time <br /> Matrix Number Not" <br /> W'� o rN 11� t <br /> Relinquished <br /> Date: 1 Time: Laboratory:. Courier: —�'7—"� �� <br /> Received by: <br /> GDate: Time: <br /> Relinquished by: <br /> Date: Time: Received by <br /> Date: Time: <br /> Relinquished by Date: <br /> Time: Received by: <br /> Requested Tum Around Time(circle): 24 hours 48 hours 72 hours 5 days(standard) er: iJ\ ` v,�'�1.. •�' (r ' <br /> Special Instructions to lab: Matrix Codes: A=Air W=Water =Solid <br /> I hereby authorize the Performance of the above indicated work. <br /> 1 fj� <br /> Geotmcker EDP to: geonackerCadvgeoenv.com Global ID: C/ <br />
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