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ARCHIVED REPORTS_XR0008065
Environmental Health - Public
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EHD Program Facility Records by Street Name
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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_XR0008065
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Entry Properties
Last modified
5/4/2020 3:37:36 PM
Creation date
5/4/2020 3:17:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008065
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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LSauers
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EHD - Public
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• <br /> CASTLE ANALYTICAL LABORATORY �raL,� u CHAIN OF CUSTODY <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 <br /> Marling Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE OF <br /> Phone (209) 3842930 - Fax (209) 384-1507 <br /> Customer ulj &Q&1U1y0r-)M(i1td" V) I4EQUFSTP ANALYSES Method of Shipment! L <br /> Address _ 5 I S1} f w �, w ch U1�:'rr h 1 <br /> Cit /State/ZIP �' 2 K o <br /> Y ' X. fV U �, cn Notes <br /> Q, _ x <br /> Phone 1 FAX I ° ° <br /> Pro # pa, y � � y a � g r? u ' � r" <br /> Report Attention .L It e, °LU <br /> Sampler Signature ° $ H m ~ �; frt �4lT�s ►� <br /> -2L- <br /> Printed <br /> Printed i <br /> Lab I.D# SAMPLE ID DATE TIME DESCRIPTION/LOCATION <br /> }a5�74 } a. <br /> f�,.jnry#X�'`'S <br /> 315 2��'�(�)` <br /> )OW ID <br /> a num Iliad to <br /> Signature Printed Name date Tima Company Name �l the laboratory <br /> Relinquished by f y !li, �! t nl CIS 1'7 [% r Note All special requests(e g quick <br /> 1 <br /> turn times)must be cleared through <br /> Received by — -� authonzed laboratory personnel <br /> Relinquished by <br /> Received by <br /> Relinquished by r r <br /> RESULTS DUE <br /> Received by l i VERBAL r WRITTEN <br /> 1 <br />
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