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ARCHIVED REPORTS_XR0008146
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_XR0008146
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Entry Properties
Last modified
5/5/2020 3:22:34 PM
Creation date
5/5/2020 2:35:19 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008146
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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EHD - Public
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R- r , <br /> s <br /> ( Advanced CHAIN OF COSTO RECORD <br /> GeoEnvironmental, Inc. Date Page of <br /> 637 Shaw Road- Stockton, California-95215- (209) 467-1006- Fax (209) 467-1116 <br /> Client —� Pro ect Mana r <br /> of Tests Required <br /> Phony NtJmber <br /> Samplers (Signature) Invace <br /> Protect Name -- AGE E] <br /> Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of Notes <br /> Number Description Comp Grab Air Conts <br /> I A>>A 3 be' XX' <br /> G D NDA PPR PMATE <br /> DF III. RIN rF- IN L RES RVED IN <br /> PR ESF-1 <br /> e inquis ( ignatu ece ve rpnatI�p Date/Time <br /> wig <br /> n <br /> Relinquished by (Signature) Received by (Signature) DatelTime� r�C✓� ,J <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysiu (Signature) EC'D SEALED &INTACT VIA � Date/Time <br /> Dispatched by (Signature) DatelTime Received for Laboratory by Date/Time <br /> Method of Shipment /� y1►j_' -�-^-� Labor tory Z <br /> f <br /> (J IA�A'i��lJ I !`�'[d G <br /> Special instructlona ��y} I hereby auttraN a the performance of the above indicated work <br /> �q Tb <br />
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