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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 /> Field Office 5ACR-A PA&-7�_'?-c� /L T Additional documents are attached, and are a park of this Record <br /> Address 7 — 3L{ TN -5r d <br /> (Z�`�, Job Name <br /> Location l 9 uvi7 E l�� <br /> LOt�_-6 F—OfZO C-A <br /> Project #NSUyl� _l Task#1 �`�82 Analysis Request <br /> Protect Manager J-04 n1 i30w6R ,- <br /> Laboratory - CCIkZ.C �'Y►� �N m <br /> Tumaround Time_.5TA N D A q:�D a roo p_ s Q 8V) y .. ` <br /> C > m U y O <br /> Samplers Name w a 9 �� ° U <br /> r m no 0!3 roo o mo cc av m o <br /> Samplers Signatur ' a�oo miy <br /> IL o 0.0 a N ga m N "o o _ Comments/ <br /> Sam le ID Date Time Matrix r m rr x cn a r r` a r Instructions z <br /> ass A k- 3,<L) 501L Af SAna nc�6� <br /> 3S 1 !k W j — 9: <br /> 3S$ bucv' <br /> If J17 <br /> Special Instructions/Commenis Relinquished by Receivedb Sample Receipt <br /> Slgn_zz'�` r6— �. Sign Total no of containers <br /> Print 3 Print Chain of custody seals <br /> Company 5 �2 Company Rec'd good condition/cold <br /> Time - Q= ° Date �Uag 4 Time Date/� Conforms to record <br /> Relrn d by Received by ilk tic, Cypti <br /> Sign Sign Client 1 <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Date Client Phone <br /> e�Ka,un�c a.,vn <br /> Date Z Lz'? /9Y Page of__.� <br />
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