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COX940SIL
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WATERLOO
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2500 – Emergency Response Program
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COX940SIL
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Last modified
4/14/2023 4:21:48 PM
Creation date
4/14/2023 4:19:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COX940SIL
PE
2546
STREET_NUMBER
1400
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95205
APN
14115002
ENTERED_DATE
5/27/2020 12:00:00 AM
SITE_LOCATION
1400 E WATERLOO RD
RECEIVED_DATE
5/26/2020 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 />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: 209 384-1507 <br />Certificate No. 2480 <br />PAGE <br /> <br />OF <br /> <br />Customer: , •/ SAMPLE TYPE composite(c) discrete/grab(d) SAMPLE MATRIX soil(s) liquid(I) vapor(v) other (o) REQUESTED ANALYSES NUMBER OF CONTAINERS II Method of Shipment! <br />Address: -LA=74'; ite,Z • BTEX/MTBE/TPH-GAS 8021/8015 TPH-DIESEL - 8015 TRPH 418.1M / SM5520C & F Oxy's / EDB / DCA by 8260 .7) <br />= m <br />(t) c., PCBs - 8082 --_, <br />: <br />--, Electronic Deliverables (EDF) City/State/ZIP: '''./,-',/.;Z<T,-f) ..-2.- - Notes: <br />. - _ ,,„„_,..., Phone / FAX: <br />_ <br />Proj# / PO# /Global ID:',,L.'"--47-V _ • --..7i-e:247' '•'-7/: .. ; -•'-7 <br />Report Attention:_.1-7/. ' - <br />Sampler Signature: --_;--.7:,,/;,;_ <br />,Sampler Printed:., r <br />,-!._ <br />Lab ID* SAMPLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />, <br />// r <br />_ <br />Signature Printed Name Date Time Company Name _ <br />Total number of containers <br />submitted to the laboratory <br />Relinquished by: Turn Around Time: <br />24 Hour <br />48 Hour I I <br />3 Day <br />5 Day (Normal) <br />Special: <br />Received by: <br />Relinquished by: <br />Received by: <br />Relinquished by: <br />Received by:
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