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3500 - Local Oversight Program
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PR0544417
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Last modified
5/2/2019 1:41:38 PM
Creation date
5/2/2019 1:38:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0544417
PE
3528
FACILITY_ID
FA0003741
FACILITY_NAME
JIFFY LUBE #598
STREET_NUMBER
1130
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
15120405
CURRENT_STATUS
02
SITE_LOCATION
1130 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
Scanner
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Tags
EHD - Public
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ANALYTICAL 2000010848 01/31/2000 <br /> LABORATORIES Analyses Request <br /> BSK_S TAT: 5 Day Chain of Custody <br /> 1414 Stanislaus Street Fresno,CA 93706-1623 Pre-Login ID#: 131005(559)497-2888,800 877-8310 (559)FAX 485-6935 Requested Analyses <br /> QJ <br /> Client Name 35 - Report AttendomJ <br /> fic *WleT. Phone i <br /> Address'\"] Project,Quote or Fo i FAX f <br /> City,State,Zip O� <br /> Copy to: System/ <br /> LAB use atlly Sampled by: 0 <br /> Date Time Comment or <br /> t Sampled Sampled Station Cod <br /> i S <br /> tYRr P P ample Description/Location e <br /> ., v� <br /> 10 -1 W - ?"t - CC. .e.� <br /> 7777 <br /> ._x <br /> Matrix Type:L-Liquid S-Solid G-Gas Additional Servs rvices A orized by: <br /> type of Hazards Associated with Samples: Rush Priority <br /> QC Data pacitag ' el H[or one) 1e447t107"ewse <br /> [iii <br /> 11 For of Custody <br /> (Signature) <br /> SI lure Print Name Company ate Time <br /> Received/Relinquished by. <br /> SRece e R is t: E <br /> t,hJtti l <br /> Received/ ednqu a y: <br /> Rpceiyt¢P ntr,. '� <br /> 'j � � t <br /> 1011 a�zt <br /> Notice:Pa or services rend red as noted herein are due in full within 30 days from when Invoiced.If not mt id,account balances are deemed Jelin uent.Delinquent balances are subject to mon IY service/re billin charges and interest cal- <br /> Notice: <br /> at /2%per month,18%pet annum.BSK&Associates shall be entitled to recover on delinquent accoun P costs of collections.Including attorneys�ea�Inr,,rrpA nri^�i^^r in iitin�finn .hnthe. i 1 +ti.•h--1 - --- - - <br />
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