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ARCHIVED REPORTS_XR0012024
Environmental Health - Public
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EHD Program Facility Records by Street Name
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W
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WILSON
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101
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2900 - Site Mitigation Program
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PR0541653
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ARCHIVED REPORTS_XR0012024
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Entry Properties
Last modified
10/10/2020 10:50:16 PM
Creation date
7/9/2020 8:27:58 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012024
RECORD_ID
PR0541653
PE
2965
FACILITY_ID
FA0023871
FACILITY_NAME
TOP FILLING STATION
STREET_NUMBER
101
Direction
S
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
APN
15125307
CURRENT_STATUS
01
SITE_LOCATION
101 S WILSON WAY
P_LOCATION
01
QC Status
Approved
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EHD - Public
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40 a -209C 69 a <br /> CASTLE ANALYTICAL LABORATORY 5 CHAIN OF CUSTODY <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 <br /> Mailing Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE OF <br /> Phone (209) 384-2930 - Fax (209) 384-1507 <br /> Customer ., �NVi r REQUESTED ANALYSES Method of Shipment <br /> Address � <br /> City/StateIZ P Q e y Notes <br /> Phone / FAX (, —//S' a V LU fn � ii <br /> W W o <br /> Ptoi # 1P0 # f 1 -17 0. a . 0 <br /> Report Attention (L� ° <br /> a <br /> ftl <br /> Sampler Signature, o. m ~ I <br /> Printed 7 <br /> Z <br /> Lsb IDO SAMPLE ID DATE TIME DESCRIPTIONILOCATION OBSERVATIONSIREMARKS <br /> MW411,44f -1VO <br /> �- -, / <br /> Jr w. - <br /> Ir fl <br /> _ r <br /> Total number of containers submitted to <br /> i tura Printed Name Date Tlme Company Name %e laboratory <br /> ' (� C /' Note All special requests(e g quick <br /> Relinquished by o! tum times)must be cleared through <br /> Received by ` --ZEA -�! /Q _' authorized laboratory personnel <br /> Relinquished b <br /> S <br /> Received by WHO al <br /> OTHER <br /> Relinquished 6y 1[t'LQ�� RESULTS DUE <br /> Received by HEA $P VERBAL WRITTEN <br />
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