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ARCHIVED REPORTS_XR0005723
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_XR0005723
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Entry Properties
Last modified
5/5/2020 3:43:43 PM
Creation date
5/5/2020 1:54:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005723
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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f�i� i� � � i♦ I_ � I_ <br /> t Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. J,,G Date Page r1 of� <br /> 837 Shaw Road- Stockton,California- 95215 - (209) 467-1008 - Fa 209)467-1118 <br /> I ' <br /> Client Pro ect Manag ?z4e&e'C <br /> Tests Required <br /> Phone Number <br /> l00 <br /> Samp ers (Signature) Invoice <br /> Prosect Name AGE <br /> (a (� Client E] <br /> a k4 <br /> Sample Location Sample Type <br /> Date Time Water Solid NO of Notes <br /> Number Description camp arab Air Copts <br /> VIM I <br /> ABYA AA 1IN ) j <br /> MIA <br /> e nu e y pat relReeelvadygna uta Dat Mme <br /> Z <br /> Relinqulshe y (Signature) Received by (Signature) Dale rime <br /> Relinquished by (Signature) Received by Mobile Laboratory for held analysis (Signature) Datefrime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by ate ime <br /> I V C)3 v <br /> Method of Shipmento N me <br /> ZN17131TIT <br /> Si eolal Instructions I hereby a raze the rformance of the above Indicated work <br /> �Ct\VI?r� �ea�e� C ie- -i eid <br /> r <br />
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