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ARCHIVED REPORTS_XR0008391
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_XR0008391
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Entry Properties
Last modified
5/18/2020 12:11:27 PM
Creation date
5/18/2020 11:28:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008391
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 <br /> SECOR !' Chain-of Custody Record <br /> �i El Additional documents are attached, and are a part of this RArd <br /> Fre ld Office 7 <br /> Address 30 y ��'fll '1 1I, Job Name — 4.1 a, ��l(uf - <br /> / i4xs ' '�-C�^i �� 9 s?' Location (9a <br /> i 44��.A Lr. , Gr4 <br /> l �I Analysis Request <br /> Project#07'7. YzTask# <br /> Project!Manager :72tm _,AeCtftf r..eoo-r+e <br /> Laboratory (D U <br /> Turnaround Time r c,�/r^�i� N N (n - M� <br /> a� ag1 u o rn7 CO i R3 C <br /> m mV v oU U cz m �1� n U <br /> !!'�� w a o c7 m[3 a <br /> Sc miller's Name �✓�N r-� �- o o o Q o 0 0 1°o o o d°r m '+ <br /> v k N V Cr Oh �W y N <br /> SE let's Si nature �E a `gym m� �� '>m Um - a y V E <br /> PI i g 0 ao ao a °o o� roo mN mo ov °1 U Comments/ z <br /> Sample ID Date Time Matrix z ►-t COR a w s`° `° a ~" a g ~ x Instructions <br /> • 'i_r,- �0"�� /k7� X Lfv <br /> x y _oZ <br /> !Y30 <br /> 4 <br /> -H-M 11.E , ly xly - a3 <br /> i 1 <br /> NO <br /> ,I r <br /> ;I <br /> } ( i <br /> Special Instructions/Comments Relinq ed,b Received by Sample Receipt <br /> Sign i J Sign Total no of containers <br /> Print i L)Ar�J Print Chain of custody seals <br /> Company nic12 — Company Rec'd in good condition/cold <br /> Time Date 13 -4 2 Time Date Conforms to record <br /> Relinquished by Received b Client <br /> Sign Sign <br /> Print IE Print .11 Client Contact <br /> i Company Company V14 ff <br /> I Client Phone <br /> Time k Date Time 1337_ --Date <br /> SECOR CUSTREC RW 2x99 <br /> Date / r -tfl/ o Pag of <br /> t <br />
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