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ARCHIVED REPORTS_XR0002919
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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H
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HAMMER
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3250
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3500 - Local Oversight Program
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PR0545251
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ARCHIVED REPORTS_XR0002919
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Entry Properties
Last modified
1/31/2020 10:33:58 AM
Creation date
1/31/2020 9:26:34 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002919
RECORD_ID
PR0545251
PE
3528
FACILITY_ID
FA0001877
FACILITY_NAME
AM PM HAMMER/I5 FOOD #83113
STREET_NUMBER
3250
Direction
W
STREET_NAME
HAMMER
STREET_TYPE
LN
City
STOCKTON
Zip
95209
APN
08240009
CURRENT_STATUS
02
SITE_LOCATION
3250 W HAMMER LN
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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M MCEW �UMD�ABM'TWY LYSIS REMQUEST ORM so MW$W' <br /> Shaw E"lro ental&Infrastructure,Inc Purchase Order 192121 <br /> 1326 North Market Boulevard,Sacramento,CA 95834 Lab CLS Labs <br /> Project Name Parkinson's Arco,Stockton Analysis Requested <br /> Project Number 880-0401A/01060000 <br /> .Project Manager Kathleen Waldo N <br /> Company Shaw Environmental&Infrastructure,Inc <br /> Address 1326 North Market Boulevard c <br /> Sacramento,CA 95834 <br /> Dir Ph (916)565-4370 / 1 AX (916)565-435 w <br /> o A <br /> Sampler's Signature (� w <br /> H REMARKS <br /> Sample LAB Sample 1 Container Types <br /> I D Date Time I D Matrix { RC1 <br /> Preservations <br /> MW-1 Water 4 4 <br /> MW-2 07 Water 4 4 <br /> MW-3 5Z- Water 4 4 <br /> MW-4 Water 4 4 <br /> MW-5 19 Water 4 4 <br /> i <br /> RELINQUIS D BY RECEIVE BY RELINQUISHED BY RECEIVED BY TURNAROUND REPORT REQUIREMENTS <br /> J11 I A.4REQUIREMENTS X I Routine Report <br /> Signature Signa Signature Signature 24 hr 48 hr 5 day II Report(Includes DUP,MS <br /> axlkiwod- Standard(--10 15 working days) MSD,as required,may be <br /> Prmted a Printed Name Printed Name Printed Name Provide Verbal Preliminary Results charged as samples) <br /> Provide FAX Preliminary Results III Data Validation Report <br /> Firm Firm Firm Firm Requested ReW bate (includes All Raw Data) <br /> RWQCB <br /> Damrri me — 1DrL Date/Time ate/Time Date/Time (MDLs/PQLs/TRACE#) <br /> RELINQUISHED BY REqEIVED BY Special Instructions/Comments Container Types Key <br /> 40 ml VOA I <br /> Signature Signature Need EDDs as required by the RWQCB CLS Labs 250 ml LPE 2 <br /> 3249 Fitzgerald Road 500 ml LPE 3 <br /> Printed Name Printed Name Reporting limit 5ppb for MTBE Rancho Cordova,Ca 95742 1 liter HDPE 4 <br /> 916-638-730I/Fx 638-4510 500 ml glass 5 <br /> Firm Firm Contact Ray Oslowskl 1 liter glass 6 <br /> 2x6 s/s ring 7 <br /> Date/'Time Date/rime giassjar 8 <br />
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