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EHD Program Facility Records by Street Name
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MELLON
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3500 - Local Oversight Program
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PR0545546
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SITE HISTORY
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Last modified
3/16/2020 9:14:47 PM
Creation date
3/16/2020 4:21:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE HISTORY
RECORD_ID
PR0545546
PE
3528
FACILITY_ID
FA0003691
FACILITY_NAME
MBM, Manteca
STREET_NUMBER
800
STREET_NAME
MELLON
STREET_TYPE
AVE
City
MANTECA
Zip
95337
CURRENT_STATUS
02
SITE_LOCATION
800 MELLON AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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-• .. _ ._:. ...,. Re ort# 24 -7 ,— U b <br /> GeoAnalytical Laboratories, Inc. Lab p <br /> Regulatory Wes ❑ No 8i21���5 <br /> Zia 1405 Kansas Avenue Phone: (209) 572-0900 Regulator: <br /> Modesto,CA 95351 Fax: (209) 572-0916 <br /> Phone: (Z©f o�7-5—_ <br /> Client: jAP AE m/L CHAIN OF CUSTODY Fax: <br /> Address: P„ To: <br /> City zip 9j'a2 Y� <br /> Project ID - Lab Use Only <br /> ti� <br /> (Print ame) <br /> Sampled By cc <br /> (Signature) Container ci <br /> Sample type Lab ID# <br /> Sample ID z a <br /> Date Time Grah Comp Matrix Type Size <br /> 53— 197jO/tel /!-st11G .% x Remarks 22� <br /> od <br /> Remarks <br /> An <br /> Relimpished by(Signature) Dal finx Receive by(Si 1 ure) — Dat Time <br /> S f-e ,' <br /> Relinquished by(Signature) Date ',�'little Recei d (Signa re) lJ late Timc <br /> Preservative: 1Q-4°C Q-HCI Q-NaOH Q-Na2S203 Q5 -HN @-H Q-H2S 04 ®-Other ®-Other <br /> Site Time: �yf /D ��� Stan: 15me: a /j7�11 HOU <br /> W Stan: Site Arrival: x2-- <br /> Start: y <br /> Finish: Total Hour: <br /> /j"� 2 5'�,OLL(,�S Approved By <br /> Mileage: •, <br />
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