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ARCHIVED REPORTS_XR0008141
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_XR0008141
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Entry Properties
Last modified
5/5/2020 3:46:12 PM
Creation date
5/5/2020 2:34:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008141
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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' <br /> CHAIN OF CUSTL� RECORD <br /> Advanced <br /> = GeoEnvironmental Inc. Date t Page 4— ofd_° <br /> 4005 North Wilson Way-Stockton,Califomia-95205-(209)467.1006-Fax(209)467-1118 <br /> Client Project Manager,' Tests Require <br /> Phone Number <br /> a <br /> w <br /> Samplers: (Signature) Invoice: <br /> Project Name AGS <br /> � U '` <br /> � Client Q <br /> Sample Type 1 <br /> Sample Location Date Time Water ^ Solid No. of �r . <br /> Number Description comp. crab. Air Conts. <br /> d-yLl <br /> S <br /> 3.21- 0 td.3 X <br /> Cry <br /> j� �v - 7 <br /> Reil,an is e : (Si ature ac 'e y: gnature ?a3� r DaletTlme <br /> .00 742--'r <br /> Relinquished b (Signature) R ved b Date/Time <br /> q y: { g ) y: (Sig lure) <br /> Relinquished by: (Signature) Received by Mobile Laboratory for field analysis: (Signature) Daleffime <br /> Dispatched by: (Signature) Date/Time Received for Laboratory by: Data/Time <br /> Method of Shipment: f � r Laboratory Name <br /> u f �VGL U rb6z�p�I��(+1 �:q.7leCc{� � <br /> Special Instructions: VOAS �llll M ALS OTHER <br /> l hereby authorize the perform a of the above indicated work. <br /> GOOD CONDITION ,/ APPROPRIATE ' <br />
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