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ARCHIVED REPORTS XR0000234
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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B
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B
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1604
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3500 - Local Oversight Program
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PR0543431
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ARCHIVED REPORTS XR0000234
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Entry Properties
Last modified
2/5/2019 3:22:36 PM
Creation date
2/5/2019 11:56:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000234
RECORD_ID
PR0543431
PE
3528
FACILITY_ID
FA0003683
FACILITY_NAME
Caltrans-Stockton
STREET_NUMBER
1604
Direction
S
STREET_NAME
B
STREET_TYPE
St
City
Stockton
Zip
95206
APN
171-090-08
CURRENT_STATUS
02
SITE_LOCATION
1604 S B St
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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M MtH� OMU ©VOECW® = = = i <br /> A vanced Technology FOR LABORATORY USE ONLY <br /> 0" <br /> `I S Method of Transport Sample Condition Upon Receipt <br /> Laboratories Logged By Date ���fine � Walk In ❑ 1 COOLER TEMP C (2 6) 5 SEALED Y❑q N❑ <br /> 1510E 33rd Street Couner �KJ 2 CHILLED Y I N Q 6 ;OF SPLS MATCHCOC Y N❑ <br /> Batch# D O x UPS ❑ J <br /> Signal Hill CA 90807 FED EXP ❑ 3 HEADSPACE(VOA) Y Cl N❑ 7 PRESERVED Y❑ N Cl <br /> (310)989-4045 +FAX(310)989-4040 PO # ATL ❑ 4 CONTAINER INTACT Y N❑ 8 CONTR LOT# <br /> Client GEOCON ENVIRONMENTAL - SACRAMENTO Address 3235 Sunrise Blvd #6 TEL ( 916 ) 852 9118 <br /> AnnJZi City Rancho Cordova State CA Zip Code 95742 FAX( 916 ) 852 9132 <br /> Project Name Project# Q fnin Sampler ""`sd"af1Bl C f �sg°atu`el <br /> Relinquished by {spa,.ar,d �� ) f Received by Isg„+tu+mdPmmWNamo )((J Date jime <br /> Relinquished by (sg^aane � ReMiVeo by tsgmbx.and Pw*.d Na UA V- `/ i '� Date rte/Time n <br /> Relinquished by (sgna"a r,d w,wad tram+) Received by tsw...a and anal l+amDate , G`T _ Time <br /> I hereby authorize ATL to perform the work indicated below Send Report To Special lnstrucuons/,C�omnmentss t <br /> Unless otherwise Project Mgr/Submitter Attn �� ✓r J� <br /> requested all <br /> samplesbe Date t Co , r h r G! <br /> drsposed 455 days Prat�"'B t LJtr <br /> Address <br /> after receipt <br /> Signature City State Zip <br /> SHIP TO LAB SHIP TO LAB SHIP TO LAB Circieor Add o CIRCLE APPROPRIATE A /_a C <br /> (SUB CONTRACT [SUB CONTRACT} {SUBCONTRACT) Analysts(es) (� h =� Z <br /> o m Sa MATRIX RTNE ❑ <br /> TEST TEST TEST Requested ��h a° OUB tiv ?� Q` cv `Q �Q Q RW{CB ❑ <br /> ATL a AT:s ATL a o {� 0 , 3 QCT OJ H <br /> m U n ❑ <br /> DATE DATE DATE m, �b RO cm y� V U J v Q d AVP <br /> CLIENT 10 CLIENT ID CLIENT ID \���} y yo° ��``am� U� \y�� Q 3ti Ir <br /> Ir NAVY <br /> ❑ <br /> LAB USE ONLY Sam le Descrl lion ?� em a� �� *U S �o s' o� Container(s) rn <br /> T Batch # p p o �°� �� p`0 0 �4 s `Q� �' o �o �P A e OTHER <br /> E �� m� "c Dry Qti h� � ' = QTAT # Type ti REMARKS <br /> M Lab No Sample I D Date bo �� bpm 4 �7h mo �o a �o o` �� oe S p YP a t <br /> 1now ` i G � L6 <br /> z MW -S <br /> 0tLO :-1 4 i I ;C <br /> InL'i±1 X' <br /> Sample ArcttnerDisoosal +TAT at a am <br /> ❑ Laboratory Siartdard TAT A= Overnight B= Emergency C- Critical D. 3'Alor Routine anew da It sam Preservatives <br /> ❑ Othw <_24 hr Next workda 22 W 3 Workda s E`7 Workda s reoenreedd aft r ,mom H=Hcl N=HNO3 S-HLSO. C=Q C <br /> ❑ Return To Container Types T=Tube V=VOA L=Liter P=Pin• J--jar B-Tedlar G=Glass P=Plastic M=Metal Z=Zn(AC)2 O=NaOH T=N t2S203 <br /> $10 00 FEE PER HAZARDOUS SAMPLE DISPOSAL DISTRIBUTION White with report Yellow to loader Pin3c to submitter <br />
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