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ARCHIVED REPORTS_XR0006639
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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Y
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YOSEMITE
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1012
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3500 - Local Oversight Program
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PR0545948
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ARCHIVED REPORTS_XR0006639
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Entry Properties
Last modified
9/29/2020 10:19:50 PM
Creation date
8/5/2020 4:06:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006639
RECORD_ID
PR0545948
PE
3528
FACILITY_ID
FA0005159
FACILITY_NAME
FILL-EM FAST
STREET_NUMBER
1012
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
21903024
CURRENT_STATUS
02
SITE_LOCATION
1012 W YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
Scanner
LSauers
Tags
EHD - Public
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180 BLUE RAVINE ROAITI= B <br /> AIR TOXICS LTD. FOLSOM, CA 95630-4719 <br /> -_ (916) 9 <br /> ,— _TAN ENVIRONMENTAL ANALYTICAL LABORATORY ��(916) 985-1000 FAX a; 002998 <br /> 85-1020 <br /> CHAIN-OF-CUSTODY RECORD Page J_ of 1 a <br /> Contact Person ©c\ Protect info s Turn Around Time. <br /> -- o , �� POS 155- "." <br /> -__ Company Normal <br /> Address 5�E GG 5( 5k k r� Ate. City Ati <br /> Stat Zip Protect# ��6� `�� ❑ Rush <br /> Phone -5-10 15-7 9010 __ FAX 5 Q Z( Protect Name ve ! Specify <br /> C a <br /> M -Lab Vacuum <br /> Field Sample I D _ Date & Time Analyses Requested Canister Pressure 1 <br /> Initial Final Receipt <br /> Collec.,teff By Print Signature otes \� <br /> r <br /> } - Relinquished By ( n e) DatelTrme Received By ( rgnature) Da me <br /> 1 5 O(� =4 <br /> _ - R 1 urshed By rg tur DateMme Ree&rveMy (Signature)[1! Dat <br /> e n y ( gnat r Date/T a ���✓✓� _,'Rev v y (Signat�"u////re) Dat r (((( u– 1 <br /> --w Shipper dame- Air Bill# Opened By Datefl'tme Temp {°C) Condition Custody Seals intact Work Order# <br /> w-Labs 7 Q C Yes No None 2 <br /> -- --_USB <br /> T= only - - <br /> y '. <br /> Farm 1293 rev 05 <br /> I� � - <br />
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