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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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EHD - Public
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Chain-of-Custody Number <br /> SEACOR Chain-of-Custody Record <br /> Feld Office. Q Additional documents are attached, and are a part of this Record <br /> Address 12--3 V - 3!7W S7-gM7 - Job Name �r�w Qic- C OM,a aiv r <br /> Location `��� E HL✓r �$ <br /> Gcr��-r--aRo <br /> Project#NOoCS '60/-01 Task# Analysis Request <br /> Project Manager �TOHN , IRO(-,57ZGo <br /> r <br /> Laboratory EX CeI4,967LA, N m U m <br /> Turnaround Time S7iA,UA/2D Dq a� <br /> -Aa _� ��' o <br /> in o <br /> 0� n O m c 0 <br /> o ooC7 a 0 a _? y U <br /> Sampler's Name m o O o 1O o m a o co m o <br /> Sampler's Signatu o �, v W = �,� ?6 Y -J H C <br /> z Y x r x a o E;2, y; N CO`� -1 Comments/ E <br /> Sample ID Date Time Matnx = w m H CO � ¢(0 �(0 z w W w a w i°—r- a Instructions zCD 0 ' <br /> ru w, - 30 -Zo- y" Sa ! CI /14 o/v <br /> MW`� ' <br /> $5 ?30 <br /> Special instructions/Comments Relinquished by Received y Sample Receipt <br /> Stgtn Sign Total no of containers <br /> Pnnt�� BB Print Chain of custody seals <br /> Company S:96:6R . --- Compan P Rec'd good condition/cold <br /> Time Dated ' Time Dat Conforms to record <br /> Relin cashed by Received by <br /> Sign Sign Client <br /> Print Pnnt <br /> Client Contact <br /> Company Company <br /> Time Date Time Date Chent Phone <br /> s (%",na <br /> Date Page . / of <br />
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