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ARCHIVED REPORTS_XR0005719
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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2402
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3500 - Local Oversight Program
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PR0545640
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ARCHIVED REPORTS_XR0005719
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Entry Properties
Last modified
5/5/2020 2:36:11 PM
Creation date
5/5/2020 1:51:53 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005719
RECORD_ID
PR0545640
PE
3528
FACILITY_ID
FA0003900
FACILITY_NAME
PACIFIC PRIDE COMMERCIAL FUEL
STREET_NUMBER
2402
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95204
APN
12506001
CURRENT_STATUS
02
SITE_LOCATION
2402 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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LSauers
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EHD - Public
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�. .�� �. ...■. 1111111 � is ta• � t, � � � Ir i• � <br /> • i <br /> ( Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page 4— Of <br /> 837 Shaw Road-Siockton, California-95215-(209)467-1006- Fax(209)467-1118 S4L _x J <br /> a= <br /> Client Project Manager c✓� <br /> CVQ')//qX Tests Required <br /> Phone Number <br /> za91 �Ln 7-IQQ <br /> Samplers- (Signature) Invoice <br /> Project NameCt;L f—v i AGS <br /> Client/tr <br /> SampleLocation Sample Type <br /> No of <br /> Number Description Date Time Water Air Solid Coots �� Q? Notes <br /> Comp Grab <br /> �' �� ARE sv� c,a+nc,�a��r�� rtiAlt..� 3 x <br /> �� ► S � ��nr ��y� / �, •'; Boli, <br /> e inis e y igna y re eve y gnature <br /> �o` ce Date/Time <br /> , <br /> (Signature--)- <br /> Relinquished by (Signature) �T�9Nr✓9R�1 <br /> Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) <br /> Date/Time <br /> Dispatched by (Signature) Date/Time Roee f Labor by, ate/T e <br /> Meth d of Shipment La ora ry ame - �� <br /> lel l De 41 r.r { <br /> Special instructions I hereby authorize the performance of the above indicated work <br /> �1 <br />
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