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ARCHIVED REPORTS_XR0002274
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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G
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GRANT LINE
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455
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3500 - Local Oversight Program
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PR0545202
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ARCHIVED REPORTS_XR0002274
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Entry Properties
Last modified
1/27/2020 11:17:40 AM
Creation date
1/27/2020 9:57:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002274
RECORD_ID
PR0545202
PE
3528
FACILITY_ID
FA0003124
FACILITY_NAME
7-ELEVEN INC. STORE #20304
STREET_NUMBER
455
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
455 W GRANT LINE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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t G T A 10500 TAMPA FL 33 UNIVERSITY <br /> CENTER DRIVE a ANDIANALYSIS REQUES ORD 23424 <br /> 12 <br /> i N V I R O N MENIAL (B13) 979-9092 two, r, .. <br /> (ti LARORAIORIES. INC. ¢ 4 ' yi, <br /> Company Name: r"I Phone#: U _/ r 3�� r <br /> 60 ❑ <br /> FAX#: ❑ � m ❑ � � <br /> Company Address: r� Site location: V10Lu s aq ❑ <br /> Project Manager: Client Project 1D: (#) ❑ + + " a ❑ ' <br /> Lp 2 O 7(o 7 G0 M ❑ Xt � � � ❑ a N a <br /> x a <br /> NAME �j m v ❑ ❑ ❑ ❑ a) ❑ p o a <br /> I attest that the proper field samtfling Sampler Name rint. ' ❑ N �; c ❑ ❑ 1 E ❑ o ❑ <br /> 3 4 0 ❑ A ❑ o . _J v Q 5 v C <br /> v U3 <br /> oracedures were used during the collection � � � ,, LV ❑ ❑ m a a � ❑ a � I. � <br /> )(these samples. ❑ m o c D CL <br /> a o ¢ ❑ ❑ L <br /> 1" Matrix Preserved Sampling a ❑ o w a S ❑ ❑ © " 8 ❑ LL <br /> Field GTEL ❑ z ❑ ❑ w w a a ❑ -0 ❑ <br /> Sample Lab # w U N o a ❑ ❑ ❑ ❑ 4 <br /> D C7 }. N N X <br /> ID (Lab use only) v w c, IL Q-w p I o v <br /> rr0 X: CF Qi� lu ti d ¢ �,(� z o Ix 0. Oar. aa. aa. to as a U a a �' <br /> 3 rn a rn a. O x x x aN v F m m s x 0 w w w w w w w w w w 0 a 0 c`� <br /> 9 <br /> t ;rs <br /> -r st30 <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS 1� <br /> Priority{24 hr} ❑ GTEI_Contact p f_ /I ,_,�„ t-k Are <br /> Expedited(49 hr) ❑ OuotelContraet# O�rS J�►-�� C�+~ p~-y� Iy <br /> 7 Business Days ❑ Contlrmatlon# <br /> Other PO# SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# U Storagelocation: <br /> Business Dee ❑ �30$� 1 <br /> OA I QC LEVEL I <br /> SLUE F1CLP❑ OTHER FAX❑ Work Order# C$DSO 12D -2-1 `4 ` <br /> Relinquished by Sa pter• Date Time Received by: <br /> 5/7 69 1 '3 <br /> CUSTODY Relinquished by: Dole Time Received by: <br /> RECORD Relinquished by: Date Time Received by Laboratory: <br /> t l.�.o.�.►..�.�tiZ - <br /> sy. <br /> aybill 0--- <br />
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