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CO0053202 (3)
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2500 – Emergency Response Program
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CO0053202 (3)
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Entry Properties
Last modified
11/20/2024 9:09:12 AM
Creation date
3/3/2021 4:37:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO0053202
PE
2546
FACILITY_NAME
VICTORIA ISLAND LP
STREET_NUMBER
16021
Direction
W
STREET_NAME
STATE ROUTE 4
City
STOCKTON
Zip
95206
APN
12919029
ENTERED_DATE
12/28/2020 12:00:00 AM
SITE_LOCATION
W HWY 4-OLD RIVER BRIDGE
RECEIVED_DATE
12/28/2020 12:00:00 AM
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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SJGOV\ymoreno
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EHD - Public
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'�Of� I1 Ce <br /> CASTLE ANALYTICAL LABORATORY CHAIN OF CUSTODY <br /> Location: 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 Certificate No.2480 <br /> Mailing Address: 2333 Shuttle Drive,Atwater, CA 95301 PAGE 1 OF____, <br /> Phone: 209)384-2930 - Fax: 209 500-1848 <br /> Customer: PG&E Stockton o REQUESTED ANALYSES Method of Shipment: <br /> Address: 4040 West Lane ) oco <br /> �C06-S�C_ <br /> 2 x o EO W <br /> City/State/ZIP: Stockton, CA 95204 W OR Z Notes: <br /> a a> F- N 'n U ro <br /> >^ o o Q <br /> Phone / FAX: (209) 942-1401 � 2 o � N z <br /> N a 'n Q = C O <br /> Proj# / PO#/Global ID: `—}tom a a > ? w - o � z 1� <br /> Report Attention: Alex teele Larsen 6 < o o m o � <br /> W <br /> Sampler Signature: a- _ WCo E <br /> Q <br /> Sampler Printed: r w 0 X of o Z <br /> � W <br /> Lab ID# SAMPLE ID DATE TIME DESCRIPTION/LOCATION m OBSERVATIONS/REMARKS <br /> ( L4 12 2 12 1 .0D 1 02 <br /> o al number of containers <br /> Signature Printed Name Date Time Company Name t submitted to the laboratory <br /> Relinquished by: Turn Around Time: <br /> Received by: 24 Hour 0 <br /> Relinquishe by: 48 Hour <br /> Received by: 3 Day 0 <br /> Relinquished by: 5 Day (Normal) <br /> Received by: Special: le—tAQ_ <br />
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