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COARKVI3W (2)
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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4929
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2500 – Emergency Response Program
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COARKVI3W (2)
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Entry Properties
Last modified
3/23/2022 2:49:30 PM
Creation date
3/23/2022 2:40:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COARKVI3W
PE
2546
STREET_NUMBER
4929
Direction
E
STREET_NAME
COLLIER
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
00520012
ENTERED_DATE
11/2/2021 12:00:00 AM
SITE_LOCATION
4929 COLLIER RD
RECEIVED_DATE
11/2/2021 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\ymoreno
Tags
EHD - Public
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CASTLE ANALYTICAL LABORATORY CHAIN OF CUSTODY <br />Location. 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 t OF t <br /> <br />Customer: PG&E Stockton SAMPLE TYPE composite(c) discrete/grab(d) SAMPLE MATRIX soil(s) vapor(v) other (o) 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 / SM55200 & F- . OJ ..:, ,.. 0 <br />a o a _ co <br />0 LL1 -- <br />_0) <br />17) t- _ . c, <br />aD <br />0.1 <br />CO PCBs - 8082 Electronic Deliverables (EDF) OeU0e--k2E 0 <br />City/State/ZIP: Stockton, CA 95204 Notes: <br />2 ND__ <br />Phone / FAX: (209) 942-1401 <br />Proj# / PO# /Global ID: 1---IC( 2c1 C__C) \ (:, ft. eivi 4, 5A .53 i <br />Report Attention: Alex S,4eele /.,..I Larsen <br />Sampler Signature: /4----,/ oeste-i---_ <br />Sampler Printed: <br />Lab ID# SAMPLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />I \ - 22\ Cp,',OD t 02_ <DI t__ ./ 1 c5: R3 <br />— <br />__. <br />— <br />, Stenature Printed Name Date Time Company Name I <br />Total number of containers <br />submitted to the laboratory <br />Relinquished by: 4, /l/ ki3t=NC -5, LA/2. i\....., 1 .3.- 2\S ‘PC,. '),. Turn Around Time: <br />24 Hour I 1 <br />48 Hour <br />3 Day <br />5 Day (Normal) <br />Special: <br />/2) --crr-Cie------ .--- A -1 _ , _ Received by.. -- - <br />Relinquished ',.../ _ <br />Received by: <br />Relinquished by: _ <br />Received by:
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