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ARCHIVED REPORTS_XR0007932
Environmental Health - Public
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EHD Program Facility Records by Street Name
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P
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PACIFIC
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4405
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2900 - Site Mitigation Program
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PR0542364
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ARCHIVED REPORTS_XR0007932
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Entry Properties
Last modified
5/4/2020 3:49:37 PM
Creation date
5/4/2020 3:09:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007932
RECORD_ID
PR0542364
PE
2960
FACILITY_ID
FA0024340
FACILITY_NAME
PACIFIC CAR WASH
STREET_NUMBER
4405
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11024014
CURRENT_STATUS
01
SITE_LOCATION
4405 PACIFIC AVE
P_LOCATION
01
QC Status
Approved
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EHD - Public
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� r � � � � I• E• t� tt� �■ � .� <br /> CAST ANALYTICAL LABORATORY CHAIN OF CUST <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 <br /> J i <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE 1 OF <br /> Phone (209) 384-2930 - Fax (209) 384-1507 <br /> Customer �; G+{ �,Cl, dl rDnQ '� REQUESTED ANALYSES Method of Shipment <br /> L <br /> Address r'05 o SG)']Lulu R � W c& o�Ierh1 h <br /> CitylStatelZlP ~ '� �p F o a J a Notes <br /> Phone 1 FAX �e _ 2-q� -- / E z <br /> W z v = w Lu O <br /> Prol # ! P 0 `�cC G r°�.S 0. W � a m o <br /> ii LL <br /> CL y CL 0 <br /> Report Attention t t ' 8 „ a a { a <br /> a E U) Q m ~ r w <br /> Sampler Signature 3 <br /> Printed 4i D <br /> �y <br /> z <br /> Lab 1D# SAMPLE Ill DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br /> o 23541 <br /> NO 108— y 23542 <br /> 23543 <br /> .V 1 4 2 <br /> L 23544 <br /> c+ 12- <br /> rA L6 13 23545 I <br /> r 2 23546 <br /> 23547 <br /> Ir <br /> 23545 <br /> 23549 <br /> Total number of con <br /> lure Printed Name Date Time Company Name theiaboratocy <br /> Relinquished by ' J r a Note All special requests(e g quick <br /> t YY1 turntimes)must be cleared through <br /> Received by ,�� i IN,`�l�r� r f ! authorized laboratory personnel <br /> Relinquished by <br /> 23550 <br /> Received by <br /> Relinquished DUEshed by � <br /> Received by D HERBAL WRITTEN <br />
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