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ARCHIVED REPORTS_XR0008133
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_XR0008133
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Entry Properties
Last modified
5/5/2020 3:07:24 PM
Creation date
5/5/2020 2:28:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008133
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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Advanced <br /> CHAIN OF CUSTODOECORD <br /> GeoEnvironmental, Inc. Date Pageg2Z of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)407-1118 <br /> Client .� Project M ger$' Tests Required <br /> f <br /> -- � Pone umber <br /> ers (Signature) Invoice, <br /> Prosect Name AGE C <br /> �x Client ❑ <br /> , -- - <br /> Sample Location Sample TypeDate Time Water Solid NQ of , <br /> Number Description Time <br /> Conts 453 57 <br /> Comp (crab k–•--�-.-.-.—_ <br /> r <br /> r 45358 <br /> 13151 45359 _ <br /> 45368 <br /> � At. 11tc �f �, 4536 ! �- <br /> a <br /> jr} 45362 <br /> f 100 <br /> Ccssqg�coE) �f �� �( 45363 <br /> naUisAed by gnat 0) 'Received y (Signature) Date/time <br /> Relinquished by (Signature) Received by (Signature) Date)Time <br /> Relinquished y (Signature) �n�y (± �iCf Ttffby M,bI4- a oratory for field analysis (Signature) Datefrime <br /> in[r[t)ilA71P,A1 Illi U 'ICS , F <br /> I , (Sign re} � Datelrime eceived for Laboratory by DateMme <br /> GOOD�CQMITION--�— p�PR�O}P�,�S�I�7eE <br /> 7 <br /> Ili"fiiPll7r71t1QW9iUlYlr111iCRJ......... Laboratory t3 e <br /> 01111 ^Special instructions k I here y au orize a pe o ante of the above Indicated work <br /> rig to r ec e l e Vt <br />
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