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ARCHIVED REPORTS_XR0008078
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_XR0008078
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Entry Properties
Last modified
5/4/2020 3:39:24 PM
Creation date
5/4/2020 3:21:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008078
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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( Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmental, Inc. Date Page 2= Of r2- <br /> 837 Shaw Road- Stockton, California 95215 - (209) 467-1006- Fax (209) 467 1118 <br /> ClientPro ect Mana <br /> Tests Required <br /> PODne N rnber <br /> '7 lot)C., <br /> S lers Signature) Invoice <br /> Project Name kY <br /> Client EJ <br /> SamAGE <br /> ple Location Sample Type <br /> Number DescnDate Time Na of <br /> ptton Water Air Solid Cants Notes <br /> Camp Grab <br /> 10, <br /> i <br /> inq is ( ignat re) ecerva y rgn.turs <br /> Relinq fished b Signature) Received b Si <br /> r p - _ y <br /> %=LMIj� � ate/7ime <br /> Relmqui <br /> 0� APYROPBUTS i ory for held analysis (Signature) <br /> rTAD SPACE ABSENT COr`� [Wo/Time <br /> � y <br /> Qrspatah Y � --�— DatelTrme Recetygd for taporatory by 1 <br /> IV" Ji ( ` 1 . Date/Time <br /> Method of Shipment + Laboratory Name R <br /> Special Instructions - ----�' , <br /> I haraby auth riz the p ofmance of the above indicated work <br />
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