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ARCHIVED REPORTS_XR0008117
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_XR0008117
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Last modified
5/5/2020 3:34:59 PM
Creation date
5/5/2020 2:19:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008117
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
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LSauers
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EHD - Public
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t Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc �� 7z Dace Page of <br /> 837 Shaw Road - Stockton, California 95215- (209) 467-1006 - Fax (209) 467 1118 <br /> �Clientr Project Mana er Tests Required <br /> 4i ji� c <br /> one umber <br /> le <br /> I Sam Si <br /> p rs (Signature)nature <br /> ) 1 Invoice <br /> w r <br /> Project Nam -� � AGEB-' <br /> 2f Client ❑ <br /> Sample Location Sample Type No <br /> Number Description <br /> Date Time Water Air Solid Contst Notes <br /> Comp Grab <br /> e�j <br /> n <br /> xl-�l <br /> 4 Alto <br /> + ' J24 <br /> + gL � <br /> + 047R. <br /> � ���iture) cy igna ure OZ- �r 1 <br /> linquibReceived by (Signature) t Oate/Time <br /> Rehnqutshed by [Signature) Received by Mobile Laboratory for Held analysis (Signature) Date(Time <br /> r � <br /> Dispatched by (Signature) DR--;me I Received for Labor tar b p /Time <br /> Method of Shipman , Loffrato Wn e <br /> Special instruct+ons "� me un" <br /> l hereby thor[za the riormance of the above indicated work <br /> r+�x <br /> i <br /> � � I• � � !•� tli � ttiiiiiiiir tttttttttt� �r � tttttttttt� � �i ta�rr� � � <br />
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