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CO2ZNEZ0F (2)
EnvironmentalHealth
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2500 – Emergency Response Program
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CO2ZNEZ0F (2)
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Entry Properties
Last modified
4/27/2021 2:33:23 PM
Creation date
4/27/2021 11:43:22 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO2ZNEZ0F
PE
2546
FACILITY_NAME
PRIVATE RESIDANCE
STREET_NUMBER
10825
Direction
E
STREET_NAME
MONCURE
STREET_TYPE
RD
City
RIPON
Zip
95336
APN
25729002
ENTERED_DATE
6/28/2020 12:00:00 AM
SITE_LOCATION
10825 MONCURE RD.
RECEIVED_DATE
6/28/2020 12:00:00 AM
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
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SJGOV\ymoreno
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EHD - Public
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Ce_ <br />CASTLE ANALYTICAL LABORATORY <br /> 06-1 <br />CHAIN OF CUSTODY <br />1..ocation: '2333 Shuttle Drive. Bldg 908/909, Atwater, CA 95301 <br />Mailing Address: 2333 Shuttle Drive, Atwater, CA 95301 <br />Phone: 209 384-2930 - Fax: 209 500-1848 <br />Certificate No. 2480 <br />PAGE k OF k <br /> <br />Customer: PG&E Stockton SAMPLE TYPE composite(c) discrete/grab(d) SAMPLE MATRIX soil(s) liquid(I) vapor(y) other (o) 2 REQUESTED ANALYSES NUMBER OF CONTAINERS Method of Shipment: ( <br />Address: 4040 West Lane BTEX/MTBE/TPH-GAS 8021/8015 TPH-DIESEL -8015 TRPH 418.1M / SM5520C & F Oxy's / EDB / DCA by 8260 8260 - full list PCBs - 8082 Electronic Deliverables (EDF) City/State/ZIP: Stockton, CA 95204 Notes: <br />Phone / FAX: (209) 942-1401 <br />Proj# / PO# /Global ID: 10ITIO Majrutzt:::: <br />Report Attention: Alex Steele Da Larsen <br />Sampler Signature: Z2 <br />Sampler Printed: O-36 L06014._) <br />Lab 1D# SAMPLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />Y\A eKrt ) kk, C_- )7 (0-2(g2) ‘\ \ 'Up 02_ C.)•V (___ 1/-- I <br />Signature Printed Name Date Time Company Name 1 <br />Total number of contaners <br />submitted to the laboretory <br />Relinquished by: .-4#/....e-its:V.-K OtsQ(::- ta4QCJek) 6-76-a) ki-)C-' Turn <br />24 <br />48 <br />3 <br />5 <br />Around Time: c <br />Received by: Y-1.1--1-----ke? Pti ,----1-4-cs, ><.,;-e, yl 7 6„21.:-. ),--,,,, Hour l_j <br />Relinquished by: Hour L. <br />Received by: Day I I <br />Relinquished by: Day (Normal) <br />Received by: Special: Z Vvit,..(2t....5=:M
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