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ARCHIVED REPORTS_XR0007128
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_XR0007128
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Entry Properties
Last modified
11/20/2024 9:21:18 AM
Creation date
9/5/2019 1:39:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007128
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
Scanner
SJGOV\wng
Tags
EHD - Public
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Chan-of Custody Number <br /> SECCUR Chain-of Custody Record <br /> Field Office D 1 Additional documents are attached, and are a part of this Record <br /> Address Job Name <br /> Location l <br /> Project#011.q,T ITOn3Task# Analysis Request <br /> _._ <br /> Project Mana er i I <br /> Laboratory o �2 y j <br /> N � <br /> Turnaround Time cl 0N <br /> co = m <br /> iL m <br /> Sampler's Name � F N o <br /> QA0co <br /> Sampler's Signature �,� a �- <br /> U a o 0..o a. �o o� R o m w o o v °' U Comments/ 3 <br /> Sam I ID Date Time Matrix x i-co w a`C r i co cn( a te a r Q Instructions z <br /> Z R_M D D I Q5 3 X `S` µ L 1 k <br /> E � <br /> Special Instructions/Comments Relinquished by Receive Sample Recei t <br /> Sign I Sign Total no of containers <br /> Print Print Chain of custody seals <br /> Company a + Company_ Recd in good condition/cold <br /> r Time 7-_ Date Time ' Date Conforms to record <br /> Relinquished by Received by Client 56CC) iZ_ <br /> ��a y Sign Sign+ <br /> Print Print Client Contact 1 �� <br /> Company _ Company <br /> Time Date Time Date Client Phone <br /> SECAR CUSTREC Rev 299 <br /> Date L o—O Page Z of <br />
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