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ARCHIVED REPORTS_XR0007087
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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88 (STATE ROUTE 88)
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14000
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3500 - Local Oversight Program
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PR0544811
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ARCHIVED REPORTS_XR0007087
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Entry Properties
Last modified
11/20/2024 9:21:17 AM
Creation date
9/5/2019 1:16:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007087
RECORD_ID
PR0544811
PE
3528
FACILITY_ID
FA0000091
FACILITY_NAME
Colonial Energy CE 40138 (DBA Power Mart)
STREET_NUMBER
14000
Direction
E
STREET_NAME
STATE ROUTE 88
City
LOCKEFORD
Zip
95237
CURRENT_STATUS
02
SITE_LOCATION
14000 E HWY 88
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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Tags
EHD - Public
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M. M Mfg M M M: M IM M M4r M <br /> Chain-of-Custody Number <br /> SEACOR Chain-of-Custody Record <br /> Field Office -sem�" M�`�` a} CA Additional documents are attached,and are a part of this Record <br /> Address t`I 3 — 3 S?' , Job Name rk.r~ D f� I OIVI.PAw� - - - <br /> Location <br /> L r+� <br /> Prosect Analysis Request <br /> # 0 0� S"�`�jD <br /> Task�LU�e� <br /> Project ManagWTei�l�' W 1, r <br /> Laboratory S 0 co <br /> Turnaround Time / yp A2� ° a <br /> ►-, gE m � `� <br /> o m ca " <br /> ro oo <br /> may/9 ro� (5 (0-5 <br /> Name - - no Mog 2oo ¢co uSampler's Signature <br /> o� `° M �`n % T§c; o m � Comments/ � <br /> U ao ao d •.o -6 cm M CD CDv e U 3 <br /> Sample ID Date Time Matrix z @ m r ¢(0 >co MCD U)0 a C $2 n ri 2 r Instructions z <br /> 5 d- DC7 Z r'�T 9!�a �tiC s 129,4 t <br /> Special Instructions/Comments Relinquished by Rec iced by Sample Receipt <br /> SignL'�_ Sign Total no of containers <br /> PrintmAd,4_ _ Pnnt Chain of custody seals <br /> Company Company Rec'd good condition/cold <br /> Time �719U Dates `� Time Date Conforms to record <br /> Relinquished by Received <br /> Sign Sign Client <br /> Print Print �� �![c <br /> Company Compan, Ce kC1NeM Client Contact <br /> Time Date Time- ? Date Z- ' Client Phone <br /> OEM=CL4KCFM Im <br /> Date 1 I,_.,, Page of <br />
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