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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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SJGOV\wng
Tags
EHD - Public
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Chain-of-Custody Number <br /> r ,^ SEACQR Chain-of-Custody Record <br /> Field Office AC- tk Additional documents are attached, and are a part of this Record <br /> Address 1-1 2> ,L4 ST r ` <br /> ... •--- Job Name <br /> Location �--c�'k <br /> C� S-t>O p <br /> Protect# fy0 _„••_ � Task# LQC@Z Analysis Request <br /> Protect Manager _Z0FJ I&PWWL r <br /> Laboratory E(L.`1. Com. 0 0D m <br /> Turnaround Time .ti ha b gbzh + cn <br /> m <br /> Samplers Name a� >° EP m -5som v <br /> oo Ua Qo �a rod <br /> Sampler's Signature �-. E vo �N wo ?c~v 20 61im `m <br /> rz <br /> U �o a o a. e o N 6 m N m�.02 p� m U Comments/ E <br /> Sample ID Date Time Matrix z i-co i-m i- ¢co >(0 2 w co'n a(0 �g a P instructions z' <br /> /c� /6;z <br /> Special Instructions/Comments Relinquished b Receive Sample Receipt <br /> Sign,--/ Sig Total no of containers <br /> Print AAP--A_- Print Chain of custody seals <br /> Com any o�"C G i-�u- Compa O a ^�Q Rec'd good condition/cold <br /> TimeDate Tame Date Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client <br /> Print Print Client Contact <br /> Company Company <br /> Time Date Time Data IClient Phone <br /> SLM=GWTKr!M 12M <br /> Date __f I (`�s Page_,_L of�__._ <br />
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