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ARCHIVED REPORTS_XR0008369
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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S
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SANTA FE
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23569
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2900 - Site Mitigation Program
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PR0541936
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ARCHIVED REPORTS_XR0008369
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Entry Properties
Last modified
5/18/2020 11:47:57 AM
Creation date
5/18/2020 11:26:15 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008369
RECORD_ID
PR0541936
PE
2957
FACILITY_ID
FA0006149
FACILITY_NAME
RANCH MARKET
STREET_NUMBER
23569
Direction
S
STREET_NAME
SANTA FE
STREET_TYPE
RD
City
RIVERBANK
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
23569 S SANTA FE RD
QC Status
Approved
Scanner
LSauers
Tags
EHD - Public
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_ Chain-of Custody Number �38 <br /> SECOR Chain-of Custody Record <br /> Feld Office V 0 Additional documents are attached, and are a part of this RAM <br /> Address <br /> Job Name <br /> —' <br /> r04 <br /> Location - <br /> 1z2j'fr&Ak. , OA <br /> Analysis Request <br /> Protect# 7 Task# <br /> ProjectManager <br /> Laboratory, o 2 <br /> Tumaround TimeOiza N o ja a <br /> o <br /> ME <br /> Sampler's Nam 8 08 N O g a o o a° ° <br /> Sampler's Signature o ,,� m ' -' <br /> U a o a'- x a N m T E o a o Comments/ <br /> Sam le lD Date Time Matrix x r CO �; m z `�' a �,. a Instructions Z <br /> W- <br /> -!Z <br /> --1 <br /> i <br /> Special Instructions/Comments Relinquished b Received by Sam le Recei <br /> Pt <br /> 4 Sign/f� Sign Total no of containers <br /> PrintOgwon -I lnat,'ci _ Prrrrt Chain of custody seals <br /> 'au) ,LgAfflWO,1-9Oe14, Compan 00C Compan Recd in good condition/cold <br /> Time <br /> _S Date 7 d Tim Date Conforms to record <br /> i <br /> Relinquished by Received by Client. <br /> Sign Sign Q2WAAAA &�� <br /> Print PnntQ�aMA AlbafaLwi__ Client Contact <br /> Comp Company,16-11- AIMI-O_'LA4 — <br /> T Phone <br /> C <br /> Date Time_S�iS Date///7�D lient <br /> sEcoa wsr,Ec w..use � <br /> Date Page of <br />
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