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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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GRANT LINE
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340
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3500 - Local Oversight Program
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PR0545199
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Last modified
1/17/2020 9:28:11 AM
Creation date
1/17/2020 8:34:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545199
PE
3528
FACILITY_ID
FA0005789
FACILITY_NAME
JUANITA MARKET #4
STREET_NUMBER
340
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
APN
23303027
CURRENT_STATUS
02
SITE_LOCATION
340 W GRANT LINE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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WESTON Anaiylics Use ,,, <br /> Custody Transfer Record/Lab Work Request _ ,i <br />� r Only <br /> WESTON Anafytic9 <br /> I Refrf erator# Use Only <br /> #aypecointaiiners. Samples Were: <br /> Client r - Volume 1 Shipped or,Hand-i <br /> Wath Order ,•1 y , r' ' -— -Dnllvered) <br /> !-_ Preservative , r `1vt)TES <br /> i Date Recd Date Due <br /> RM-Contact_._.�._._.�., ..ANALYSES.-_ <br /> 2 Ambient or Chilled <br /> Client ContecuPhone -_- REQUESTED NOTES: •�'„ <br /> i f <br /> A Use Only Date <br /> -- 1 Client iD/De9cription Matrix.. r CF-) �` 3 Received Brokery <br /> - ' <br /> Cob to- - Collected- <br />, 1 r r Leaking(Improperly <br /> Sealed) <br /> NOTES: <br /> "-•�.+..' � YPreserved <br /> I ; 4 Proper! <br /> �•+�` 5 Received Within <br /> Molding Times <br /> Y ) N <br /> NOTES: <br /> COCPrape a resent onOuterr <br /> Package Y N <br /> 2 Unbroken on Outer <br /> Package Y N <br /> 3 Present on Sample <br /> Y N <br /> Matrix: W-Water DS-Drum Solids X•Other Special Instructions: 4 Untxoken on Sample <br /> s•Sox a-Olt DL-Drum Liquids NOTES: Y N <br /> S£-Sediment A-Air F-Fish <br /> SO-Solid Vn-YArw L- EPMCLPLeeehate <br /> C <br /> fte la son Relinquished ReceiveU D Date Time item)Reason Re' i b eid b Date Time RecordWas: <br /> � kveI Present <br /> t Upon Receipt <br /> !C '/ of SamplwY N <br /> Discrepancies Between _ <br /> Sample Labels and COC, <br /> Record? Y <br /> NOTES: C <br /> RFW 21-21-001lA-1213$ 7-1t5 <br /> I <br />
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