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ARCHIVED REPORTS_XR0013016
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545485
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ARCHIVED REPORTS_XR0013016
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Entry Properties
Last modified
3/11/2020 1:09:57 AM
Creation date
3/10/2020 11:43:06 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0013016
RECORD_ID
PR0545485
PE
3528
FACILITY_ID
FA0003604
FACILITY_NAME
BEACON STATION #3492*
STREET_NUMBER
470
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
22307101
CURRENT_STATUS
02
SITE_LOCATION
470 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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r r r r r r r r r r r r r r r r r r r <br /> Unramar Inc. BEAC oN <br /> CHAIN OF CUSTODY REPORT <br /> un�r�r <br /> Beacon Station No. Sampler(Print Name) / Date Farm No. <br /> ?� /Plcff'40 /�Ll�l-N ANALYSES of <br /> Project No. S p (Signature) 0 <br /> 96102- - 7-- <br /> oject Location litionPr75 <br /> LU __ <br /> Sample No./Identification Date Time Lab No. m z°i REMARKS <br /> R fished by: (Signatur Affiliation) Date Time Receiv d by: ?/Affiliation)(Affiliation) Date Time <br /> Reli uish by: ( ' nature/Affiliation) Date Time Received by: (Sig nature/Affilialion) Date Time <br /> Relinquished by: (Signature/Affiliation) Date Time Rece'd by: ( ignature/Affiliation) Date Time <br /> ReportTo: e C A�� lir' Bill to: QJ, <br /> RAMAR INC. <br /> 25 West Third Street <br /> 56e, Z,o Hanford, CA 93230 !, <br /> A,-. Attention: _--�r, kz" <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy ��PINK: Originator Copy <br />
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