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ARCHIVED REPORTS_XR0004391
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545488
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ARCHIVED REPORTS_XR0004391
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Entry Properties
Last modified
3/13/2020 8:03:45 AM
Creation date
3/10/2020 4:58:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004391
RECORD_ID
PR0545488
PE
3528
FACILITY_ID
FA0001393
FACILITY_NAME
MANTECA LIQUOR & FOOD
STREET_NUMBER
890
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
22302007
CURRENT_STATUS
02
SITE_LOCATION
890 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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PARKER CHAIN OF CUSTODY FORM <br /> Environmental Services <br /> 190 East 7th Street <br /> Pittsburg, CA 94565 lent' CvnOMEP, GO emy. 3 I <br /> (594) 439-9024 SiteNf-meaH AfEg P <br /> Date iV Ly 60 <br /> Fax (510) 439-2666 Location: an fi 9p N -MA{ S'T. <br /> Semple Type Analysis Requested <br /> Number Soil Water Time TPH-g TPH-d BTEX O & Q 8240 Metals Qlst) Asbestos Other Remarks <br /> 04 x 1114 x x <br /> MW.Z x 3 x <br /> A x <br /> F <br /> • X 3�6 x X <br /> } <br /> I <br /> ..,( r L L J,lVa - <br /> GOODND�t!0 . .., <br /> �R PF1lA <br /> I <br /> i 1�0e-f - 4 4 0 <br /> Sampler Nems (Print) /�1 A '� '�- VV � L J Sampler SignatureV 4# " <br /> ft04V1f-7#V <br /> t d Time Recel t3 , Data and Time Sampling Site Sketch LOvI� I Y; <br /> � � �i�, �fsy S,� <br /> JN <br /> oN �� <br /> ME <br /> i qu ed 6y D t and Time Received By Date and Time J S L 1 N A 1 v�K <br /> Relinquished By Date and Time Received By hate and Time MAN 17 <br /> Relinquished By. Date and Time Received By Date and Time [J <br />
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