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ARCHIVED REPORTS XR0006971
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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103
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3500 - Local Oversight Program
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PR0544638
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ARCHIVED REPORTS XR0006971
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Entry Properties
Last modified
7/9/2019 2:49:02 PM
Creation date
7/9/2019 2:14:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006971
RECORD_ID
PR0544638
PE
3528
FACILITY_ID
FA0004027
FACILITY_NAME
HENDRIX FORK LIFT INC
STREET_NUMBER
103
Direction
N
STREET_NAME
E
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15318001
CURRENT_STATUS
02
SITE_LOCATION
103 N E ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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r t,fiAlIN VJV LUN UDY 1 LABORORY ANALYSES REQUEST FORM <br /> 1433 North Market Boulevard,Sacramento,CA 95834 Sery quest No: .Purchase Order: i <br /> f111C (916) 928-3300 FAX(916)928-3341 Lab: CAS <br /> Project Name: Teicltert&Sons,Stockton Analysis Requested <br /> i Project Number: 20F90-002.007 <br /> (Project Manager: Matt Turner o <br /> Company: Pinnaclev co <br /> !Address: 3939 Cambridge Road,Suite 220 So a o <br /> Cameron Park,CA 95682 ¢ Q Q <br /> Phone: (530)676-6884 w w _y r• <br /> FAX: (530)676-6885 ° a a � <br /> Sampler's Signature: tj X ate, <br /> AB REMARKS <br /> H <br /> N p�q O <br /> Sample Lamp e ;z:. <br /> I.D. Date Time I.D. Matrix Container Types <br /> Preservations <br /> TK-5E 3123199 16:14 11 soil 1 X X <br /> TK-5CE 3123199 16:16 soil I X X <br /> TK-5CW 3123199 I6:20 soil 1 X X <br /> TK-5W 3123199 15:35 M soil I X X <br /> TK-6E 3123199 16:02 soil 1 X X <br /> TK-6CE 3123199 16:07 soil I X X <br /> TK-6CW 3123199 16:10 soil I X X <br /> TK-6W 3123199 15:38 soil 1 Yx X <br /> REL( QUIS U�w <br /> Y RELINQUISHED BY RECEIVED B y� TURNAROUND REPORT REQUIREMENTS <br /> REQUIREMENTS X 1. Routine Report <br /> Si nature S atuSignature SignaturePV 24 hr 49 hr s day Il. Report(includes DUP,MS <br /> Harold duke S(� / (.�ry} Slandard(-10-15swrkin da x <br /> s v) MSD,as required,may he <br /> Printed Mime Printed Name Printed Name Printed Name Provide verbal Prehminar Rcsulls <br /> /��} r charged as samples} <br /> EMCON ` lq Provide FAX Prelmurar <br /> r Residhs 111-Data Validation Report <br /> Jet Fir Firm Firm Requesied Repon Dare (includes All Raw Data) <br /> RWQCB <br /> Datelfi a Da /Ti a Date/Time IDatcrTime {MDLs/PQLsrrCRACEH) <br /> RELINQUISHED BY RECEIVED BY Special Instructions,!C°m ents Container Types Key: <br /> I att ���r 1 �� �r 40 ml VOA: I <br /> Signature Signature 1) For oxygenates,analyze for MTBE,TBA,DIPE,ETRE,and TAME 250 ml LPE: 2 <br /> using 8264 500 ml LPE: 3 <br /> Printed Name Printed Name 2) If total lead by 7420 is greater than 50 ppm,then analyze for total lead by 7421 1 liter HDPE: 4 <br /> Firm Firm <br /> 500 in]glass: 5 <br /> 5 l 1 liter glass: 6 <br /> DaterfimeDate/Time 2x6 s/s ring: 7 <br /> glass jar: $ <br />
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