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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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TRACY
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1210
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2900 - Site Mitigation Program
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PR0515694
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COMPLIANCE INFO
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Entry Properties
Last modified
9/3/2020 11:07:36 AM
Creation date
9/3/2020 10:48:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0515694
PE
2950
FACILITY_ID
FA0012289
FACILITY_NAME
CSK AUTO
STREET_NUMBER
1210
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
Zip
95376
APN
23229060
CURRENT_STATUS
02
SITE_LOCATION
1210 TRACY BLVD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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.4' Del MarAnalOcd <br /> 20"A Mon <br /> 0"AMon An.,Irsln4 CA 1010011 2111032 FAX(US)201-IZ24 <br /> 1071m Wor,SuE.C—*Dr.,1v1w A WOW CA 00121{KCl 37"M FAX(10n fl410M 007918 <br /> n <br /> 1/621110 C.11,Vn*.I^ >7► <br /> I^CA"on(110j1141 FUt!114)nS-i 11 `• <br /> 11x1 I eft,91dd9'2SMWA O.CA0Mn nC9)609-0% F"(�r CHAIN OF CUSTODY FORM -� <br /> s/e/p,ati,�s a.,a,r 114�.r,kwy,,CA 1212a(1191 101�l11 FAx(e11J 1os.1/11 D7 <br /> Pape Z of <br /> Giant Name/Address: Project/PO Number: <br /> G'Ednrx /mac.. /?C—./2z— �,�� Ana"is Required40 <br /> c. <br /> n) <br /> (?i7-Y, e-A- S-G-e-41- Yo ily i °3 <br /> Project Manager: Phone Number q b ci' <br /> c�tllc C'�,.�wssrs- �yi��S�y-tl�c� <br /> Sampler: Fax Num e: <br /> /esc;-Jr ,/. Tr.►. r CYef yoy—lt�`1t <br /> Sample Semple Container 0 of Sampling Preservatives <br /> f)escripGan Matrix Type Cont. Z DalelTime Special lrstrulors <br /> n> <br /> f>7 1 oo X 77. if 114D• <br /> 1 <br /> e — t—Am is S x c) <br /> c� <br /> nCn� <br /> r") <br /> —j <br /> 1 <br /> O> <br /> C) <br /> n) <br /> r <br /> O) <br /> c) <br /> Relinquishe;Bly: <br /> Dale!rime: Received by: Date lime: Turnaround Time: (Check)`'7: 00 1713 same day 72 hoursR ulsheate e: R-sceived by: Date frame: 24 hours 5 days _ <br /> 48 hours normal <br /> ReNnquls Date frame: R in Laub.by: Date lrime: Sample Integrity: (Check) <br /> .X �` /g D G l O� C'��t�l � 's!Gv� z1--/9-00 intact ,G. on Ice ,� l0G *: <br /> Note: By reNnqulshlrvg ca3WDOIMSrAnalytical,client spread to pay or sennees requested on this challn of custody form and any ad hional analyses pe rT-n on this project. aymertt or sery cas s o> <br /> due wk*n 30 days from the date of invoice.Sample(s)will be disposed of after 30 da-15. T <br /> �DEx COC-GO o> <br />
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