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ARCHIVED REPORTS_XR0008116
Environmental Health - Public
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EHD Program Facility Records by Street Name
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PACIFIC
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4511
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3500 - Local Oversight Program
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PR0545641
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ARCHIVED REPORTS_XR0008116
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Entry Properties
Last modified
5/5/2020 3:19:08 PM
Creation date
5/5/2020 2:19:04 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008116
RECORD_ID
PR0545641
PE
3528
FACILITY_ID
FA0002480
FACILITY_NAME
SHOP N GO 3
STREET_NUMBER
4511
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11023011
CURRENT_STATUS
02
SITE_LOCATION
4511 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
LSauers
Tags
EHD - Public
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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date i tzl Page 1 of 07-- <br /> 837 Shaw Road-Stockton, Califomia-95215- (209)457-1008 - Fax(209)487-1118 n 7 - 0 7 <br /> Client Project Manager V <br /> .� i %t� Tests Required <br /> Phone umber <br /> -= <br /> Samplers (Signature) Invoice <br /> Project Namet AGE <br /> - <br /> 4 G 'AAAlA; 1!1/1w-f Client <br /> Sample Location SampleType <br /> Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts .., <br /> �'w 1 0 1WL4 lmyyk e50 PC <br /> A,wz tA&WZ �i 13 e-� Ll 1C <br /> ^M19 Y"LA u138 e c <br /> by wS <br /> OAW� 1h'' >C +C <br /> ww 11 ftW i t I }° x <br /> i�w!nqs( W\VV 1 3 (03 W K <br /> wa y +gnat Received y (Signature) <br /> Daterrime <br /> quashed by (Signature) Received by (Signature) Datelrime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatofTime <br /> Dispatched by (Signature) Date(Time fiats ve or Laboratory by Date/Ti <br /> ` ! � <br /> Method of Shipment Laboratory N �� <br /> Special lnalruOuris t ��_ ( 1 1 har author+za the performance of above indicated work <br />
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