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ARCHIVED REPORTS_XR0005117
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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M
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MOFFAT
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229
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3500 - Local Oversight Program
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PR0545566
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ARCHIVED REPORTS_XR0005117
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Entry Properties
Last modified
9/23/2020 10:53:58 PM
Creation date
3/17/2020 4:42:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005117
RECORD_ID
PR0545566
PE
3528
FACILITY_ID
FA0005479
FACILITY_NAME
MANTECA BEAN CO
STREET_NUMBER
229
STREET_NAME
MOFFAT
STREET_TYPE
BLVD
City
MANTECA
Zip
95336
CURRENT_STATUS
02
SITE_LOCATION
229 MOFFAT BLVD
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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i 4080 PIKE LANE, SUITE C CHAIN-01 -GUSTUDY RECORD <br /> G* LCONCORD, CA 94520 AND ANALYSIS REQUEST 30154 <br /> (510} 685-7852 n7_;,"�""_�' ' b;"""'w ''�"`"""`_, <br /> FN 'RONMENTA L i ' 4 " —s �r i ` t <br /> ASORATORIES iNc (800) 423-7143 <br /> Company Name yy-- I �_ Phone# <br /> OU }Atm `Tci:6 FAX# ❑ ❑ <br /> a <br /> Company Address 6o Site locationkCLt CA W ❑ r ❑ <br /> Protect Manager I Client Project ID (#) a ❑ + + <br /> {� 03$7Q 6!oS` La ca <br /> m Z ' ¢ � CD <br /> C�1r1" I!E OGi NAME t„ ❑ ❑ ❑ ❑ z © o ❑ ❑ ^❑ rr <br /> I attest that the proper field sampling Sampler Name(Punt) = a ❑ _� _ ❑ ❑ d q U a ❑CL S <br /> procedures were used during the collection N _ `� ❑ a m e a m � c <br /> of these samples MCA ' 1 Chi ❑ � � � � � a � o a CL � � � � � "� ❑ � <br /> y Me hod <br /> Matrix Sampling co e N Co a. a a ©©p © o o $ <br /> y Preserved P 9 v} y n ❑ W w w O ❑ ❑ ❑ p N ❑ <br /> Field GTEL © ,� ❑ ❑ ❑ ❑ a ❑ R y Y o 2 ❑ <br /> Sample Lab # FiDIL8 <br /> co aC i c� to 0 m O N c rnID (Lab use only) oo a o ° W F = c3 u�i a s = v oN v m m x T o o a a a a a a a a v a ¢ J �' o <br /> W W W W W W W W W F W U ..J O U <br /> Vow Tfea <br /> v r TryAwAy IN F l <br /> RST l p 1 1611 _ <br /> 6 <br /> Vu w <br /> r � <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS �` I <br /> Priority(24 hr) ❑ GTEL Contact <br /> Expedited(48 hr) ❑ Quotelcontract# <br /> 7 Business Days ❑ Confirmation# <br /> Other POM SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Das ❑ <br /> QA/QC LEVEL <br /> BLUE❑ CLP❑ OTHER FAX Work Order# 209-0 <br /> Relinquished D Time Received by <br /> 10=/1c 7 y adv <br /> CUSTODYRelinRelinquished by q s by at Time Received <br /> RECORD �yy31 <br /> Date Time Rece1 by Laboratory <br /> 0 <br /> nev 7191 / Waybill # <br />
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