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ARCHIVED REPORTS_XR0005130
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_XR0005130
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Entry Properties
Last modified
9/23/2020 11:17:13 PM
Creation date
3/17/2020 4:49:55 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005130
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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0 Aft <br /> 4080 PIKE LANE SUITE C CHAIN-OF-CUSTODY RECORD <br /> IGTEL CONCORD, CA 94520 AND ANALYSIS REQUEST 36674 <br /> (510) 685-7852 <br /> (800)423-7143 <br /> 1 <br /> a <br /> Company Name Phone# ttl0 <br /> I <br /> rtI I l i <br /> FAX# <br /> Cc raany Address Site Location m <br /> o <br /> 11 ; <br /> o <br /> raect Manager Client Project ID (#)� ��, �► �� (� a ISI 2 N a ' a r, <br /> j 9 It.no o d � m m o ' y m <br /> l` SLL M T o l l Nt I I z z I rr <br /> I, <br /> I attest that the proper field sampling Sampler Name(Print) a o1 o v I I } I o a a V ° C) V' I I <br /> U)procedures were used during the „ ° 3 1 l o <br /> collection of these samples ( I31 o - ^ a Q o <br /> N 11 M U &nO O I N N I <br /> 0 <br /> l l rmw lO <br /> M rn m 7 <br /> I NMethod a aOampng a coo Preserved tw w <br /> W ro riField GTEL o 1 <br /> i I <br /> 0. <br /> m i <br /> Sample Lab# a w c� �' o s N o N N X " I <br /> ID (Lab Use l o � 0 a = w ¢° x w w a = n �o �o o a G <br /> !! u' m m a a 4 <br /> only u 3 cgi a vj a O i i i $ ~ a } ' a a W a a a a a a a C) a s d ° o -- <br /> rK T x O w w w w w w w w w f w U O U <br /> I <br /> l i <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS <br /> Priority(24 hrj (j GTEL Contact <br /> Expedited(48 hr) r 1 Quote/Contract# <br /> 7 Business Days J Confirmation# <br /> Other SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> Business Days J P O #' <br /> QA/QC LevAla—2 C>� <br /> Blue i_1 CLP F 7 Other❑ FAX❑ Work Order# S zl/ <br /> Reli uis d by mple Date�y rile Received by <br /> Q `�`- ' 2,1-7 <br /> CUSTODY Relinqut ed by Date Time Received by <br /> RECORD <br /> Relinquished by Date Time Received by Laboratory <br /> 117L1-5-i 3 Waybill 9 - z <br />
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