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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
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LSauers
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EHD - Public
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+— �tittititt� ■� �� I: i s� � � � � � � � !� � <br /> L <br /> Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date Page Z, of <br /> of Northern Calrfortitta ' <br /> Zf i <br /> 1803 West March Lane State A Stockton Calilornia 95207-(209)956-0264-Fax(209)956-0700qCrF 7J ta� <br /> Client Protect Manager ; <br /> Tests Re utr4 <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Protect Name AGE E]� !/ � <br /> Client <br /> ❑ <br /> Sample Location Sample Type No of <br /> Number Description Date Time Water Solid k� Notes <br /> p Comp Grab Air COnlS <br /> 2 <br /> 82472 ; <br /> ✓ � K � � , <br /> V0A &GJMETALSJ0THER <br /> GOOD CONDITION APPROP IATE <br /> HEAD SPACE ABSENT _ CONTAIN RS <br /> c ingws e y {Signature) eccive y tgnature Daternme <br /> CA Dveim t kt f4WOf 77q-r 1 a <br /> Re inquis cd by (Signature) Received by Signat o) Df1a1Tlme <br /> CA- kf MQ, 1D 3I �p� <br /> Relinquished by (Si tura) Roc ed by Mobile Laboratory for field analysis (Signa,uro) Dale►Time <br /> Dispatched by (Signature) Date/Time Raceivad for Laboratory by Date/Time <br /> Method of Shipment CAOIQA h�.CV <br /> �`CL . ,t 4- L j&J a Laboratory Nam <br /> (? <br /> Special ins[tuctions ' cbl✓ f hereby authorize thle performance of the above Indicated work <br /> W <br />
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