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ARCHIVED REPORTS_XR0004449
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004449
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Entry Properties
Last modified
2/6/2020 4:39:43 PM
Creation date
2/6/2020 3:51:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004449
RECORD_ID
PR0545347
PE
3528
FACILITY_ID
FA0003685
FACILITY_NAME
DBA CIRCLEK, REFUEL PETROLEUM INC.
STREET_NUMBER
419
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21938610
CURRENT_STATUS
02
SITE_LOCATION
419 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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—L- 4 <br /> GeoAnalytical LabAtories, Inc. Lab Report# AOUP - 1 <br /> Regulatory El Yes 0 No CC: Q Yes Q No <br /> 1A <br /> 1405 Kansas Avenue, Suite "A" Phone: (209) 572-0900 Regulator: <br /> Modesto,CA 95351 Fax: (209) 572-0916 <br /> Phone: L <br /> Client: W H F=- E-NVIP-oh M Env 4-rg,L— CHAIN OF CUSTODY Fax: <br /> Address: &, Lf 2-2 Original To: y— <br /> City 14K Lre— c4-- zip <br /> X <br /> Project ID <br /> Ud Lab Use Only <br /> A7 <br /> (Print Name) <br /> Sampled By 4Z9dr*L�/ki'M chg"J <br /> (Signature) <br /> Container U T <br /> Sample type <br /> z <br /> Lab. IDD .. <br /> Date Time Grab Comp Matrix Sample ID Type Size <br /> Remarks <br /> Remarks <br /> -Relinquished by I Signature) Date Time >Received by(Signature)1-14�--gpl A'15"O'pj tTime t <br /> Relinquished by(Signature) Date Time2- <br /> Received by(Signature) Dale- lime i <br /> Preservative Matrix <br /> Q-4°C @-HGL @-NaOH 10-NaS203 0-HNO3 @-H,SO, G-Other Drinking Water AwWaste Water 4WHazardous Waste(Water) @SojVSofjd <br /> Site Timc; Driving Time Mileage <br /> Start: rime: <br /> Finish: Total flours: Start: Site Arrival: x2=Tolal: <br /> Turnaround Time CIStandard Milvcr Rush OGold Rush OPlatinum Rush 00ther: <br />
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