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3500 - Local Oversight Program
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PR0545420
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
3/5/2020 5:33:06 PM
Creation date
3/5/2020 4:20:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545420
PE
3528
FACILITY_ID
FA0003815
FACILITY_NAME
TESORO (SPEEDWAY) 68154
STREET_NUMBER
2500
Direction
W
STREET_NAME
LODI
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
02740006
CURRENT_STATUS
02
SITE_LOCATION
2500 W LODI AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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Billing Inf rra/tio r� Alpha Analytical, Inc. <br /> Name �4 i" Mt`t r `fie , 255 Glendale Avenue,Suile 21 <br /> Address <br /> X35 yv C>"me+an f�Ar� nrrt Sparks,Nevada 89431-57713 Page# ofi <br /> 1 <br /> City,State,Zip MM n PAYK (fif 15692— Ai Phone (775)355-1044 <br /> Phone Numbe ]� ) Pax 55P '76 Fax (775)355-0406 Analyses Required <br /> Client Name c P.O.41 Job 41 <br /> 115 A�S� ►'� �`►'� 2aa57-pGS=a1 <br /> Address Pws# DWR a N <br /> 30 unW (C)LIN - X200 <br /> City,stale,zip P e Fax# �. Q <br /> MA-'& �U c P,gt�a1 �L 67�- 6Fpj {5 76Zc S' • <br /> Time Date = OftOnUse 5ampiedhy 5Loyt,r J] RepodAtterrtion V �oW7+°I TOtalar�diype0i y .h�v� <br /> Sampled Sampled See Key Only i• ID111Mers O ,�j <br /> $elpw Labl0Num17er Sample Description "5�tlelow R1rMAF31CS <br /> 614 Sa 000.5 I - o MW iv 5 es <br /> S14 so 02- Mw+Q —0.5 & x K <br /> MW2 — W, f DS X <br /> Srb o s s. 74 <br /> 5 50 Soil, bavm f f co;rAps17-e ra$ <br /> 4s— <br /> A <br /> ADDITIONAL INSTRUCTIONS: ' <br /> Signature Print Name Company Date Time <br /> Relinquished by SC � [l. !� s6DI ]�f r � s +iVdh wt P.r�t S ,' fq <br /> Received by hnlv-114 Ll,�� EfM7 <br /> Relinquished by <br /> Received by <br /> Retinquished by rF�G <br /> Received by <br /> 'Key; AQ-Aqueous SO-Soil WA-Waste OT-Other ": L-Liter V-Voa S-Soil Jar 0-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br /> NOTE: Samples are discarded 60 days after results are reported unless other arrangements are made. Hazardous samples will be returned to client or disposed of at client expense. The report for the analysis <br /> of the above samples is applicable only to chose samples received by the laboratory with this coc, The liability of the laboratory is limited to the amount paid for the report. <br />
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