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ARCHIVED REPORTS_XR0008072
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_XR0008072
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Entry Properties
Last modified
5/4/2020 3:54:47 PM
Creation date
5/4/2020 3:19:00 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008072
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
Scanner
LSauers
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EHD - Public
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CHAIN OF CUSTODAECORD <br /> Advanced <br /> GeoEnvironmental, Inc. Date d-L(- © 3. page at <br /> 837 Shaw Road - Stockton California-95215- (209)467-1406- Fax(209)467-1118 <br /> Client f r ry Project Manar 11c— Tests Required <br /> Phone Number <br /> J-/Ca-7 - 46 <br /> Samplers (Signature) Invoice <br /> Project Name <br /> � AGE �R <br /> 6 9 Client ❑ <br /> Sample Location Sam1e Type <br /> Date Time rya epSolid No of � N Notes <br /> Number DescriptionnComp I Grab Air Corns <br /> z8 a,51Q`If5 W <br /> (Old) <br /> iW ASA IIA 3 l"I(r l <br /> ,► tea MLJ 15 1�LS <br /> �p►wl r,Sc 11� leas ��C. It ���� � / l �� <br /> e l urs a y {Signature) eee�ve y (signature) f]atelTima <br /> e inquished by (Signature) Received by (Signature) Dater ime <br /> el 403 4� <br /> Relinquished by (Signature) Received by Mobile Laboratory for field anaiyai (S nature) Date(Time <br /> k.. <br /> Dispatched by (Signature) UatelTimeacew d f ab rat �byX. te/Time <br /> Method of Shipment /} Lab atory�me <br /> Special Instructions I �•„ U �� 1 hereby uthorize the performance of the ILbove indicated work <br />
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