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ARCHIVED REPORTS_XR0008165
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_XR0008165
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Entry Properties
Last modified
5/5/2020 3:07:14 PM
Creation date
5/5/2020 2:41:20 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008165
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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titer �� Bfiffffffififil ■� � fi (! � � � i♦ � � � � �4r <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnviron,mental, Inc. Date A9141#7 Page of Z 1t <br /> - of Nonhenr Cahfonuu <br /> 1803 West March Lano,Sudo A Stockton, California 95207-(209)956-0264 Fax(209)956.0700 'F'79 x AGE 330 <br /> Client Protect Manager o r <br /> i _ ok ! „�.� Tests Ae 0ir�ed <br /> Phone Number �) <br /> 4iW- l4757 <br /> Samplers (Signature) invoice <br /> IIi�a <br /> W �1.,,�p� AGE [J <br /> Protect Name (/��� � Client ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of � ��� �� Notes <br /> Number Description cemp Grab Air Conts � <br /> 82465 ; <br /> r ' <br /> 82466 <br /> l <br /> 45 ,i f ,� 82467 } <br /> lb- _� 2°S ✓ C 82468 <br /> t <br /> _ �� w ✓ 3t <br /> 82469 tY <br /> ' 82470 <br /> f <br /> 82471 <br /> e�ISI ��t.( ignature) occwo y ignalure <br /> CA OVEaKI614r /J4( <br /> Relinquished by (Signature) Received by (Signature) DalarTlmeA- <br /> CDV E�k61}T 10 31 °O <br /> Relinquished by (Signature) Recciv by Mobile Laboratory for field analysis (Signature) Datel7tme <br /> Dispatched by (Signature) Dalcjime Receivod for Laboratory by Date/Time <br /> Method of Shipman - k WD l}a 1, A n c"o fSd/Y Lu(- i- Vw{-vit�ivt C,nw Laboratory Namo <br /> Special instructions [J" '�j I hereby authorize the performance of the above indicated work <br />
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