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ARCHIVED REPORTS_XR0004598
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0507835
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ARCHIVED REPORTS_XR0004598
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Entry Properties
Last modified
9/15/2020 10:40:25 PM
Creation date
3/5/2020 12:00:54 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004598
RECORD_ID
PR0507835
PE
2950
FACILITY_ID
FA0007793
FACILITY_NAME
SUPER STOP MARKET
STREET_NUMBER
290
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
22309101
CURRENT_STATUS
02
SITE_LOCATION
290 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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CHAIN OF CUSTODY RECORD Bill To SHERWOOD LABS <br /> P o BOX 937 <br /> 8071 N Lander Avenue HILMAR, CA 95324 <br /> Sherwood <br /> P Box 937 <br /> Hilmar, California 95324 <br /> all abs (209) 667-5258 Attenbon Phone <br /> C O R P o F7 'A T 1 o N FAX (209) 667-2581 VICKI RUBIS 209-667-5258 Page of <br /> Job Number PO # Project Name <br /> CARDOZA (SUPER STOP) <br /> Samplers (Signature) Site Address <br /> �v 'C <br /> SAMPLE LOCATION DATE TIME NUMBER TYPE SAMPLEOR <br /> (IDENTIFICATION) (MTFVDAY(YR) (HOURlMIN) OF (GRAB CONTAINERS COMPOSITE) MATRIX �� \/ REMARKS <br /> 1 <br /> MW-1 11-26-04 1 003 3 grab W J ✓ ✓ ✓ -' /D 09 rtlao(� W�` <br /> 1050 �✓ — P/C/&, rL rgerVPGL t l� h d <br /> —MW-3 0916 <br /> 0830 <br /> DatemeRelmqu ad By (Signatur Date/Time Received By (Signature) TURNAROUND TIME <br /> Relin had By (Signature) DateMme Ace ed y Signature) Darme 24 HOUR Ll <br /> Imgwshed By (Signature) D eTm R esqfive y (Signature) Dae ma 5 DAY <br /> DISTRIBUTION Ongmai Accompanies Shipment Canary Copy Sherwood Pink Copy Sampler NOTE Samples are discarded 30 days after results are repwed unless other arrangements are made <br />
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