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ARCHIVED REPORTS_XR0008121
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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4511
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3500 - Local Oversight Program
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PR0545641
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ARCHIVED REPORTS_XR0008121
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Entry Properties
Last modified
5/5/2020 3:35:13 PM
Creation date
5/5/2020 2:23:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008121
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
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EHD - Public
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i, i• i [ti ■i i i i i i i i i i i i i i i � <br /> i i C <br /> CD <br /> Advanced CHAIN OF CUSTODY RECORD <br /> y+ GeoEnvironmental, Inc �3� oa4g i DTI Daae a �a�g � � <br /> 837 Shaw Road- Stockton, Cahfamfa- 95215-(209)487-1008 Fax 209 4 n <br /> ( ) 87 1118 <br /> w <br /> Client project n <br /> ro <br /> Tests Required <br /> P ne umber n <br /> v <br /> F- <br /> a (S mature) F1 <br /> Invoice: n <br /> Protect Name ~ ~ <br /> AGt_ <br /> / Client ❑ <br /> Sample Location Sample Type <br /> Number Description Date Time Water Air Solid No Con of � ~ <br /> Comp Grab Notes <br /> /or, <br /> N <br /> z. ( -- 81702 _ <br /> z v <br /> ----31703 <br /> f <br /> z-a � __0170N <br /> Irs --� x - - -8170-5 <br /> fa2,� � _ _ s7os 0 <br /> 811707 <br /> s+n4ma y + allure eo ve y +gna e <br /> 0 <br /> tefTime <br /> lietinqu Aad by (Signa re) Received by (Signature) N <br /> Date/Time <br /> (D <br /> Relinquished by (Signature) Received by Mobile laboratory for field analysis (Signature) <br /> DateRirrse � <br /> Dispatched by (Signature) Dalai I ims aeowved for Labolato <br /> Method of shipment Labor cry N7�; <br /> am <br /> LI <br /> Special Instructions to <br /> I hereby a or a t <br /> pert ants of the above indicated work <br /> N <br /> � r <br /> r <br /> Tfh <br />
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