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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0539716
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Last modified
2/11/2019 4:22:59 PM
Creation date
2/11/2019 3:32:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0539716
PE
2950
FACILITY_ID
FA0022723
FACILITY_NAME
WALDO ROSE STORAGE
STREET_NUMBER
1919
Direction
N
STREET_NAME
BROADWAY
STREET_TYPE
AVE
City
STOCKTON
Zip
95205
APN
14315001
CURRENT_STATUS
01
SITE_LOCATION
1919 N BROADWAY AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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® McCampbell Analytical, Inc. CHAIN OF CUSTODY RECORD <br /> O 1534 Willow Pass Rd. / Pittsburg, Co. 94565-1701 <br /> TURNAROUND TIME: RUSH❑ 1 DAY 2 DAY❑ 3 DAY ❑ 5 DA <br /> O www.mccampbell.com / main@mccompbell.com GeoTracker EDFQ PDF❑ EDD❑ Write On(DW)[:k EQu1S❑ 10 DAY❑ <br /> Telephone: (877) 252-9262/ Fax: (925) 252-9269 <br /> Effluent Sample Requiring"J"flag❑ UST Clean Up Fund Project❑;Claim# <br /> Report To: Bill To: Analysis Rec,uest <br /> Company: hj <br /> E-Mail: rh r.�J cc_v.SJ�tr, d T <br /> 1 <br /> Tele: aG ) Fax: ( ) o N00 <br /> o <br /> c h <br /> Project#: Project Name: <br /> c e + N Z o e o E <br /> Project Location: Purchase Order# <br /> Sampler Si nature d ;, 2 ° s c e g e e > <br /> SAMPLING MATRIX METHOD a V U = o 0 0 r <br /> PRESERVED a N N g oo <br /> Vi O W <br /> Location/ y [ o 17 3 <br /> SAMPLE ID field Poin m <br /> Z <br /> N N O O a <br /> Name Date Time a 9 3 _ ° a i o S N N y E <br /> 3 < H <br /> o <br /> Z 0411 3'IS (Q <br /> **MAI clients MUST disclose any dangerous chemicals known to be present in their submitted samples in concentrations that may cause immediate harm or serious future health endangerment as a result of brief, <br /> gloved,open air,sample handling by MAI staff.Non-disclosure incurs an immediate$250 surcharge and the client is subject to'full legal liability for harm suffered. Thank you for your understanding and for allowing <br /> us to work safely. <br /> Relinquishe Date- Time: Received By: �J ,, l� ICEX COMMENTS: <br /> / <br /> V `/( '' GOOD TION <br /> HEAD PACE ABSENT <br /> Relinquished By: Date: Time: ec ve DECHLORINATED IN LAB <br /> APPROPRIATE CONTAINERS <br /> PRESERVED IN LAB <br /> Relinquished By: Date: Time: Received By: VOAS O&G METALS OTHER HAZARDOUS: <br /> PRESERVATION pH<2 Page 17 of 8 <br />
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