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FIELD DOCUMENTS_CASE 2
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FIELD DOCUMENTS_CASE 2
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Last modified
3/13/2020 10:20:03 AM
Creation date
3/10/2020 11:57:21 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
CASE 2
RECORD_ID
PR0545492
PE
3528
FACILITY_ID
FA0000309
FACILITY_NAME
MCHENRY STATION & MINI MART
STREET_NUMBER
1405
STREET_NAME
MAIN
STREET_TYPE
ST
City
ESCALON
Zip
95320
CURRENT_STATUS
02
SITE_LOCATION
1405 MAIN ST
P_LOCATION
06
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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W- 7 � �U3 _O ' i . <br /> ab Report#- � -�•� GeoAnalytical Laboratories, IncInc. <br /> Regulatory )Sl Yes O No <br /> 1405 Kansas Avenue Phone: (209) 572-0900 <br /> Modesto,CA 95351 Fax: (209)572-0916 Regulator: <br /> Phone: (aOq) S{35 — D759 <br /> Client: W,-t a 4,+ E n s're,►.. h In, r v►c.e s„1:,\c. CHAIN OF CUSTODY Fax: &3--s -57/52 <br /> Address: 6 7 E /O7-/, To: To 1�v� (^U n G VX o< <br /> City T zip 95"3 7(o �h <br /> Project ID ,E _ _ Lab Use Only <br /> >r ti� <br /> (Print Name) <br /> Sampled By Rl�harel GArw) <br /> (Signature) Container �Q <br /> Sample type o Lab ID# <br /> Date Time Sample ID a, <br /> Grab Comp Matrix Type Size <br /> 6#(j9 ;Z C7 X 5 S GU .S} /Y /_'�► Remarks <br /> 7 .3-0 150aWi 9t <br /> l o <br /> 6 g <br /> L 76 <br /> Ung a lz ' l 7 <br /> Remarks <br /> Relinquished by(Signature) Date Time Rj11cejyWbyDate Time <br /> a l 9 /0:,)5 ,,c e-,_ c__ <br /> Relinquished by(Signature) Dae Time Received by(Signature) Date Time <br /> Preservative: Q-4°C Q-HCI Q-NaOH ®-Na2S203 Q5 -HNO, 0-H2S 01 7Q-Other ®-Other <br /> Site Time: Driving Time: y Total Hours <br /> Start: 6,'00 Finish: Total Hours: Start: . tc $:Oi7 x2= <br /> Mileage: Ao K Z = 32 n de.5- Approved By: ZEZAIZ:::� <br />
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