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CO0043319
EnvironmentalHealth
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2500 – Emergency Response Program
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CO0043319
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Entry Properties
Last modified
12/3/2020 7:41:10 PM
Creation date
2/12/2019 9:12:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO0043319
PE
2546
STREET_NUMBER
21264
Direction
E
STREET_NAME
RIVER
STREET_TYPE
RD
City
ESCALON
Zip
95320
APN
24524007
ENTERED_DATE
4/19/2017 12:00:00 AM
SITE_LOCATION
21264 E RIVER RD
RECEIVED_DATE
4/19/2017 12:00:00 AM
QC Status
Approved
Scanner
ADMIN
Supplemental fields
FilePath
\MIGRATIONS\R\RIVER\21264\CO0043319.PDF
Tags
EHD - Public
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Pacific Gas t{vy Z 62 i'mu (Rev 2/99) <br /> andEiectric Environmen al Affairs <br /> Company <br /> Chain of Custody Record cU <br /> From: Pacific Gas&Electric Company ❑PG&E Facility ❑ Sample Site Ship To: Lab Name: Castle Analytical Laboratory <br /> Address or Location: Oakdale S/C—811 W.J Street Address: 2333 Shuttle Drive (Bldg 908) <br /> City: Oakdale ,CA (zip) 95361 City: Atwater .CA zi 95301 <br /> Contact Name/Phone No.: Tom Hudson (209)770-6025 Phone No. (_209) 384-2930 <br /> Contact Name: <br /> Turnaround Time Analysis Requested <br /> ❑NORMAL(10 days or less) EIRUSH ❑OTHER,Specify <br /> o�ozan� <br /> ❑TELEPHONE ❑FAX Give Results to: Wayne Pacheco (wtol@pee com) <br /> Project Name: Project Supervisor(Name/Phone No.): <br /> Sampled by: (Signature) (Print Name)�H K✓f� �,� <br /> Satnnie No./ Samppled / Containers `\ <br /> Equipment Serial No. 11 Date Time Sample Type/Description No. Size Remarks <br /> 1.:J4...AYIZ_5_Z.................Y...19................__...ry�r ,M�......ol---_ ...... ..._l....- ..-.....0z_... >s...._._........._...... - - . .......- .._ _....._ ...............................---.......__................._............._............... <br /> ......- <br /> 4. <br /> -....—- — __....._.__..................................._..-.._..__._... <br /> 11. ... ..._.-_......._.._._._..__----...__..--------....._._.............__.............---.......__... <br /> 12. <br /> Reli tt�mas-h(�ed by e t. : Dgfe1&CT�) `a�q R by(N pt J: ' D Ti �,L Ship Via: t� <br /> RelinquisHhd by(Name&Dept):� Dlate&Y'ildc! R t y(N ept : r Bill of Lading/Airrbill No.: <br /> Relinquished by(Name&DepQ: Date&Time: Received by(Name&Dept.): ➢ate&Time: <br /> PM k 3�3 Z, HOS Sample Site Location: Z/ 2 6 y E. /Q vei /lo/ Sample City: f s Cq h <br />
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