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ARCHIVED REPORTS_XR0012033
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_XR0012033
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Entry Properties
Last modified
10/10/2020 10:56:14 PM
Creation date
7/9/2020 8:31:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012033
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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�..�.■ �r� arm rE�trr � ��■ E! Ei• � i� � � � � � �� � <br /> CASTLE ANALYTICAL LABORATORY 9�r,3�xPi6�31� CHAIN OF CUSTODY <br /> Location 2333 Shuttle Dnve, Bldg 9081909, Atwater, CA 95301 Certificate No 2079 I <br /> Maurng Address 2333 Shuttle Drive, Atwater, CA 95301 PAGE / Oil <br /> Phone (209) 384 2930 - Fax (209) 384-1507 T�T� <br /> Customer pp V{r REQUESTN ANALYSES Ln Method of Shipment <br /> Address M WrakLao V— R m a ti 2A-) <br /> City/State/ZIP Q s p N R o �, ° a Notes <br /> Phone ! FAX qS -0 D yUj - § b d LU L z �krz�4��nt�ed <br /> Pro) # 1 P O # - � 5 a rm- o o �A ,�•�]lyl�-ACS <br /> Report Attention w a a a W <br /> Sampler Signature a E m ~ ~ �� <br /> t in <br /> z <br /> Printed � � H � z <br /> Lab IDS SAMPLE ID DATE TIME DESCRIPTIONILOCATION OBSERVATIONSIREMARKS <br /> } Mcg- _ <br /> + w- - q 2: <br /> + H w - -9 <br /> } r!w-q q-Zs-- d <br /> + M w R <br /> t' Sa <br /> + Vu,. Z35 <br /> � -�� ;yo <br /> VW <br /> Vons I ON <br /> RESERVA ION <br /> GOODCOND :4 -AFMP81 GE <br /> HEM SPACE CONTAINE <br /> Total number of containers submiHed to <br /> Signature Printed Name Date Time Company Name the laboratory <br /> Relinquished byC, }fZr' � j; O Note All special requests(e g quick <br /> Received b J1�;ec.�} - tum times)must be cleared through i <br /> Y a ��� 4 authorized laboratory personnel <br /> r <br /> E <br /> Relinquished y <br /> I <br /> Received by 1 <br /> DUE <br /> RESULTS <br /> Rtlmqutshed by _ <br /> Recerved by VERBAL WRITTEN <br /> I <br />
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