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INSTALL_2022
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0518288
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INSTALL_2022
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Entry Properties
Last modified
1/18/2023 9:33:30 AM
Creation date
5/31/2022 1:10:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
INSTALL
FileName_PostFix
2022
RECORD_ID
PR0518288
PE
2351
FACILITY_ID
FA0013810
FACILITY_NAME
COSTCO WHOLESALE #658
STREET_NUMBER
3250
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95377
CURRENT_STATUS
01
SITE_LOCATION
3250 W GRANT LINE RD
P_LOCATION
03
QC Status
Approved
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SJGOV\kblackwell
Tags
EHD - Public
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WccAn,: ly6c, <br /> Et1YIRONMENTAL SCIENCES <br /> Chain of Custody and Cooler Receipt Form for 2214240 Page 4 of 5 <br /> PACE AkA[.YTICAL COOLER FOW <br /> RECEIPT .l Page <br /> RECEIPT + <br /> 8ubmisslon#: <br /> SHIPPING INFORMATION-SHIPPING CONTAINER FREE LIQUID <br /> Fed Ex L2 UPS C 0501 GLS�O Hand Delivery ❑ Ice Chc;t- None _ Box ::i YES'r NO <br /> Pace Lab Field Service C Other❑(Specify} Other Lr rSpecify j S <br /> Refrigerant: Ic Z Blue Ice C None C Other L: Comments: <br /> Cuslody Seals 1 e Chest G Containers❑ None Comments: <br /> InLlcta vas O N0�7 Intact?Yes No tl <br /> Alf sarnpin!;recofved? Ye5Z NO 17 All samples containers intact? Y OeJt_ Descriptiools;match Coo? Yvx-a-No G <br /> OC Received Em �_ 'issivity: Container: -A. ometer ID. L� GatslTima&-A9-f}'LZ <br /> bV <br /> E5 ❑NO <br /> YFAemporature: L/ J f `C r j C } c Analyst ln:_ <br /> SAMPLE NUMBERS <br /> SAMPLE CONTAINERS <br /> + Y 1 o t r J a tt <br /> T 11 1'NV l <br /> Jat16..c11Mr I'r:G\I•NIS <br /> ru Cr" <br /> t t IN4114GAN11. .t 'L '1 E''.1 LS <br /> MORGA NW('fE?teC.V.\I ETA7.5 Jm f karf 14t. -"---•-- <br /> PT('YACIDF. <br /> PT NITRI?EN FOR115 <br /> wr 1' T. Si I I 1 <br /> —1 <br /> u...VITKAT1J SITRf rf <br /> €Pl'f'llEhitr.t7.0S}G1:S DE\IASD <br /> IY V rimsci It'.S _ <br /> Jo(nl FOA VI U.TJL%V 17.III-VS K <br /> 40r-}L(IA t'4.1 j f <br /> Y1 ODOR <br /> L ---_ - <br /> BACTER701.0CICAL — <br /> Jdm+'IR PIAI-!Ul <br /> ill FTA S!apfda.l�W}al.a -rte..y + <br /> IIT ETA S[AL81S IA i <br /> (lt F t.%&2S:TWO G/.WANK I � <br /> �•a-EPA 5461 <br /> 1'9A aln <br /> kir 14tn'?her <br /> 0011,�I.t;1,•f <br /> DCII 1"I.AL <br /> �;rier nc <br /> -- <br /> 'TEoI_lR RAG <br /> YFAROVS 1110', I <br /> tc\crikl: <br /> Confmaents: k -- I lttnl- "' <br /> Sample NumticWng Completed 9y._ �1 Oatelrlme: a` Rw2305,2aal <br /> A=Actual , C-Correeled _ :a-.wc..+•n..�•r •c,u tovrronvvsaf(acrt.:ll <br /> The results•in this report apply to rhe samples•analv_ed in accordance with the chain of custody document.This analytical report must be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting party. Pace Analytical assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> ReportID: 1001318187 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.pacelabs.com Page 7 of 79 <br />
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