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SITE INFORMATION AND CORRESPONDENCE
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545776
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
5/28/2020 4:51:36 PM
Creation date
5/28/2020 4:36:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545776
PE
3528
FACILITY_ID
FA0002231
FACILITY_NAME
JACK FROST ICE SERVICE
STREET_NUMBER
425
Direction
N
STREET_NAME
UNION
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15112003
CURRENT_STATUS
02
SITE_LOCATION
425 N UNION ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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F <br /> WHF Environmental Consultants, Inc. <br /> Post Of ice B7 <br /> x 6729 ., <br /> CHAIN OF CUSTODY RECORD o;CA 953 5-6729 <br /> (2" 79-8138 <br /> N <br /> PROJECT NAME: � ! X G C C 6 <br /> SAMPLERS (signature) / <br /> Member <br /> .v <br /> Station - of �` l VS REKVXS <br /> Number Date Time u Station location tacrosers <br /> 17 X N c krN jL La F 57G, <br /> 2� N0AT AkI-f� . ;�S x � OF Fac � Y <br /> w ; <br /> ,�.�S.T- .�.4�► Lir tF' L)�c -_ , <br /> - <br /> S <br /> CI <br /> N <br /> V/ f X <br /> Rel' fished by(signature): Date / Time Received by (signature): Relinquished by(signature):. pate / Time Received by (signature): <br /> . <br /> Company or Agency: Company or. Agency: Company or Agency: <br /> Coaepany or Agency: <br /> a <br /> Relinquished by(signature): Date / Time Received by (Signature): Relinquished by: pate / Time Received by (signature): <br /> Company or Agency: <br /> Company or Agency:' Company or Agency: Company or Agency: <br /> Relinquished by(signature): Date / Time Received for Laboratory by: Date / Time Remarks/Shipping information <br /> Company or Agency: (s' re) <br /> f <br />
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