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ARCHIVED REPORTS_XR0012029
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_XR0012029
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Entry Properties
Last modified
10/10/2020 10:53:37 PM
Creation date
7/9/2020 8:29:01 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012029
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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CASTLE ANALYTICAL LABORATORYt�N0. <br /> �� J CHAIN OF CUSTODY <br /> Location 2333 Shuttle Drive, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 1J <br /> Manrng Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE OF <br /> Phone [2091 384 2930 - Fax (209) 384-1507 <br /> Customer <br /> I �` , REQUEST ANALYSES Method of Shipment <br /> v �Q � ,I t c�' 7• +t <br /> Address C " cv,141 ;•� t'� R r 2C/� <br /> � w <br /> City/State/ZIP �„_,,r Y. / CSC -�� ° <br /> �, o �, a Notes t��. <br /> Phone I FAX -C _ - . C .11I w a 6 w U) CO a V*teweA SeAAIeA <br /> Lu <br /> CL W CL <br /> Prof # 1 P 0 # —� –2 <br /> Deport Attention �-- Y , - . Lu FL 4 °� <br /> Sampler Signature 0 `� N m ' Co <br /> Printed N <br /> Z <br /> t'c <br /> Lab ID# SAMPLE ID DATE TIME DESCAIPTIONILOCATION OBSERVATION5IREMARKS <br /> Z z" I VIP, t 90574 <br /> �{ <br /> + M IL <br /> 90575 <br /> } 111k) jZtz 12,Wt 90576 <br /> t V, 1, 90577 <br /> 90578 ` <br /> J 905?9 <br /> 90580 ' <br /> 90581 <br /> i <br /> Total numPN94onlainers submitted to <br /> grLature Printed Name Date Time Company Name the tabo-rfty <br /> Relinquished by I ' / L;L� / �r� Note All special requests(e g quick <br /> tum times)must be cleared through <br /> Received by !i' G authorized laboratory personnel <br /> [Received <br /> by <br /> elinquished by G RESULTS DUE <br /> eceived by VERBAL WRITTEN 1 <br /> HEAD SPACE A WU-je. OMfRS,2/,_ <br />
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