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CO0055520
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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ACACIA
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2500 – Emergency Response Program
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CO0055520
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Entry Properties
Last modified
3/17/2023 4:50:42 PM
Creation date
3/17/2023 4:49:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO0055520
PE
2546
STREET_NUMBER
1330
Direction
W
STREET_NAME
ACACIA
STREET_TYPE
ST
City
STOCKTON
Zip
95203
APN
13522303
ENTERED_DATE
1/13/2023 12:00:00 AM
SITE_LOCATION
1330 W ACACIA ST, STOCKTON, CA95203
RECEIVED_DATE
1/12/2023 12:00:00 AM
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\bmascaro
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EHD - Public
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CASTLE ANALYTICAL LABORATORY <br /> <br />Castle MR )3°1055 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: 209 384-293Q- Fax: 209 384-1507 <br />Certificate No. 2480 <br />PAGE k OF Lt <br /> <br />Customer: PG -,S- SAMPLE TYPE composite(c) discrete/grab(d) SAMPLE MATRIX sod(s) liquid(1) vapor(v) other (o) J REQUESTED ANALYSES , NUMBER OF CONTAINERS Method of Shipment: <br />01:-.-U0taz60 Address: Lkt_,Lk Co t..,J e$-N- ut...) BTEX/MTBE/TPH-GAS 8021/8015 TPH-DIESEL - 8015 TRPH 418 1M / SM5520C & F Oxys / EDB / DCA by 8260 8260 - full list PCBs - 8082 Electronic Deliverables (EDF) City/State/ZIP: SI- (' \CX-01.._...) CA. q -20A Notes: <br />(2L3 I-1- Phone / FAX: 7( C( <br />, <br />‘-t? ‘, 4 ok <br />Proj# / PO# /Global ID: c•TC4-7 INA \j- 8 OA Ot_Y---, LOC.A1- i C4-7S <br />Report Attention:ett,79;;.?a,7-7,LE,i Vat\ DE,- L.PacS1... <br />Sampler Signature: <br />Printed: °ALAS L-04V12.4SE4- ,Sampler <br />Lab ID# SAMPLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />4471(p PEITIeg 1--11-23 \ 02_ CDR__ I l <br />I330 ft e.etc.\ A l-12:23 <br />i'13::. Plic,h6 Pt t-12-23 I 0? Ott "43"1,/ '1 <br />/3431 TtiN1 a 1-1023 1 oz._ CS,K-- v/ 1 <br />7.15Cti. Q .%\lf9e. 1-111-23 1 02._ oil._ V A <br />2j.izy 3 Bk_r__. 1 -9-z3 to-2_, c_t: I__ 1 <br />.. <br />Signature Printed Name Date Time Company Name <br />6, <br />submitted <br />i rtituedmbzh oef containers <br />Relinquished by: ary,,,/d„,„.„...._ (fkLx=s- t_Pka,5.-4,) 11Q25 Pal -0 Turn Around Time: <br />Received by: /4.1„--. MO re nO Hip 23 1-A0 cf x.s4-1 e_ 24 <br />48 <br />3 <br />5 <br />Hour El <br />Relinquished by: Hour LII <br />Received by: Day LII <br />Relinquished by: Day (Normal) LIII <br />Special: Received by:
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