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ARCHIVED REPORTS_XR0008149
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_XR0008149
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Entry Properties
Last modified
5/5/2020 3:30:01 PM
Creation date
5/5/2020 2:36:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008149
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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7 CHAIN OF,CUSTODY RECORD <br /> t Advanced � r I <br /> GeoEnvironmental, Inc a�U -� tante Page _ Of <br /> 837 Shaw Road - Stockton, California- 95215 - (209)467-1006 - Fax (209) 467-1118 <br /> Client , L Project M,n er Tests Required <br /> ne7mber <br /> �'7 0 <br /> Svrsl "Lll <br /> ignature) Invoice <br /> Project Nam � � � AGS <br /> Chent ❑ <br /> Sample Location Sample Type ` <br /> [}ate Time No of <br /> Number Description <br /> comp VateGrab Air Solid Conts � Notes <br /> 3 <br /> si�t}Dc5 4' iv i 3 ` <br /> e t quaa gna re Receivedy r re to in <br /> t—VL <br /> Reltnqulshed by lStgnatufe) Received by (Signature) D�tT me <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Stgnalure) Date/Time <br /> Dispatched by (Stgnalure) Date/Ttme i Received for Laboratory byD e(Ttma <br /> �llv '573 <br /> Method of Shipment Laboralor Na <br /> Speoial)nstruct ns�/v� / ����n� C� �a E here Drize th erformanse of the above indicated work <br />
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