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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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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
Scanner
LSauers
Tags
EHD - Public
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McCamn ell Analytical Inc. <br /> 110 Second venue South,#D7 CHAIN-OF-CUSTODY RECORD page t of 1 <br /> Pacheco,CA 94553 5560 <br /> (925)798 1620 WorkOrder 0209327 <br /> Client <br /> Advanced GeoEnvironmental, Inc TEL (209)467-1006 <br /> 837 Shaw Road FAX (209)467-1118 <br /> Stockton, CA 95215 Prolecthlo Pacific Mini Mart <br /> PO 20-Sep-02 <br /> Requested Tests <br /> _ — T <br /> Sample ID ChentSamplD Matrix Collection Date Hold S1V14500H+B 5W8035C 802iB!$0'E5 - SW82606 I —� <br /> 0209327 002 Effluent Waier 9119!02 12 1500 PM- -C <br /> 0209327-001 Influent Water 9119102 12 30 00 PM I C A B <br /> _ �- _ ____- - ..__ <br /> Comments <br /> -- - --- - - - --- -- - Date/Time - - - -- -- — Date/Time -- <br /> Relinquished by -- --- — -- _-- — — - Received by -- - - - - <br /> Relinquished by — _— — --- - _ Received by <br /> Relinquished by _— — _ _ _ Received by <br /> NOTE Samples are discarded 60 days after results are reported unless other arrangements are made Hazardous samples will be returned to client or disposed of at client expense <br /> Bottle Type L-Liter V-Voa S-Soil Jar 0-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br />
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