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ARCHIVED REPORTS_XR0005128
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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3500 - Local Oversight Program
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PR0545566
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ARCHIVED REPORTS_XR0005128
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Entry Properties
Last modified
9/23/2020 11:13:16 PM
Creation date
3/17/2020 4:48:55 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005128
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 <br /> 4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD <br /> CONCORD, CA 94320 36569 <br /> IGTEL (510) 685-7852AND ANALY$!$REQUEST(800 423-7143 <br /> � � I <br /> Company lame Phone# 70) <br /> 6C0 0a Wulff I"h- -TKFAx a �[a) 6ti5` � 1_I I , 2 1 1 <br /> Company Address 90&7 r,r� Site Location ��[� of�� �' � I I Iz o1 <br /> II is IS a <br /> Project Manager Y Client Project ID (q) C1O / n " " ° a fI IZ4 <br /> 4't � Z- OILt.3 <br /> c4lrl1t1 r+ t�L{! w o� f 7 Nl 11 { I z ca �, lJ f co <br /> 1 attest that the proper field sampling Sampler Name(Print) 0 1 I in _M z 1 I I I ; L I m <br /> procedures were used during the rn.+ /} L I t s f 1 m a a s� Icf <br /> collection of lhese samples N <br /> Method !p <br /> u�i in ¢ 0 f I m m I I 4 0 <br /> yr Matrix $ampling o - C e m t, o w a ¢ t l 1 1 H g <br /> x Preserved ,, H a „ I a a s M I0 11 <br /> Field GTEL w 1 1 x C [ 1 w w a a m �° y I3 f 1 <br /> Sample Lab # a w U NNom c� pp gyp} qQl a n d ��7 <br /> Q tX t8 a i1 b (Y c0 t0 tP !�6 LSD !D O CJ C Ji <br /> ID 1Lab�LlSe1 O ¢ U w as ua w 'uj a n m a a a a a a a F ¢ b <br /> ` y = a !- t- > a n a a a a a a a k. L) a ¢ d e <br /> a 3 w ¢ v� a o x r x �? �N Q_ a M m m s s 0 >- w w w w w w w w w r w v o <br /> Of a 1ST <br /> OZ 1 S d r <br /> i <br /> j <br /> t � <br /> i <br /> I <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS (}� <br /> Priority(24 hr) r 1 GTEL Contact 1` 1 <br /> Expedited 149 hr) 1 I Quole/Contract tY <br /> 7 Bus+Hess Days z ! <br /> Other S Confirmation# <br /> Business Days P O # SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot 4 Storage Location j <br /> e?C <br /> QA/QC Level <br /> Nue f 1 CLP f I Other f I _ _ FAX© Work Order# C-C: 707 _ C-) { <br /> Ralrnquished by Sampler Daite Time Received by <br /> CUSTODY 7 6"10 <br /> RECORD Relinquished by wake Time Received by <br /> Relinquished by Date Time <br /> Received by Laboratory <br /> 7�Z Z jL1 C 15.4 Waybill <br />
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