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ARCHIVED REPORTS_XR0007939
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_XR0007939
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Entry Properties
Last modified
5/4/2020 3:54:12 PM
Creation date
5/4/2020 3:11:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007939
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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tI� � ttl� �� tI_ ttttlttttttt4tttttttttt� Ittttttttt� t1♦ -a <br /> 7%TLE ANALYTxCAL LABORATORY g _ CHAIN OF CU oDY <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 f <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE_J_OF { <br /> Phone (2091384-2930 - Fax (209) 384-1507 <br /> Customer 1 c P( , , Cj v ,n yt , REQUESTED ANALYSES Method of Shipment <br /> Address ybQ 5 Njcrj lu ,� ` H <br /> CltylStatelZlP Sick o- 954 °° z <br /> ^al _ vT Nates <br /> Phone / FAX q 7 I vC1l� — Ill ° c, <br /> Pro] # ! Pt] # j 1 Y ao -1g D- 00 p + 0 <br /> Report Attention r— w a a �o 0 <br /> Sampler Signature a $ m r m <br /> Printed n <br /> M z <br /> Lab IDO SAMPLE ID DATE TIME DESCRIPTIONILOCATION OBSERVATIONSIREMARKS <br /> IR <br /> 7-3 a I -5 <br /> I -3 IIi <br /> t.t,1 7, <br /> A 1.10 Z L10 <br /> AALklq <br /> 9 � <br /> a <br /> t, <br /> I � <br /> 10 <br /> 7otat number of containers submiNed ID <br /> Signature Printed Name Date Time Company Name the laboratDry <br /> Relinquished by at as r'— ', I I t p !y d Nate All special requests(e g quick <br /> tum times)must be cleared through <br /> Received by /" . U e l x: S• t uthoraed laboratory personnel <br /> Relinquished 6y tr +� r ,r r <br /> Received byER <br /> F( if <br /> i r ;� <br /> Relinquished by iii lv r1}i'„ I's�i'! til, n111 RESULTS DUE <br /> JJ - <br /> iIieR9Ce1Ved by , VERBAL WRITTEN <br /> Rez-,eivecl SexxJfzL cxmJ to+ae4- bj 00.1 Overrxtgr+_ mi/, <br />
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