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COEDRQ2NL
Environmental Health - Public
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2500 – Emergency Response Program
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COEDRQ2NL
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Entry Properties
Last modified
9/9/2021 1:46:56 PM
Creation date
2/7/2019 10:38:01 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COEDRQ2NL
PE
2546
FACILITY_NAME
I-5 South Onramp
STREET_NUMBER
2130
STREET_NAME
FONTANA
STREET_TYPE
AVE
City
STOCKTON
Zip
95204
ENTERED_DATE
12/8/2017 12:00:00 AM
RECEIVED_DATE
12/8/2017 12:00:00 AM
QC Status
Approved
Scanner
ADMIN
Supplemental fields
FilePath
\MIGRATIONS\F\FONTANA\2130\COEDRQ2NL.PDF
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EHD - Public
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O® McCampbell Analytical, Inc. A. AIN OF CUSTODY RECORD <br /> O1534 Willow Pass Rd. /Plttsburg, Co.94565-1701 TURN AROUND TIME: RUSH I DAY Q 2 DAY U 3 DAY Q 5 DAY QI <br /> www.mccampbell.com / main@mccompbell.com GcoTrackor EDF U PDF U EDD Q1 Write On(DUD ems l0 DAY Q <br /> Telephone: (877) 252-9262/ Fax: (925) 252-9269 1C. Q Q Q <br /> vEffluent Sample Requiring"J"flog UST Clean Up Fund Project[J;Claim lam_ <br /> Re ort To: a �, n Hill To: p �„ r r_ v wG„a And ale Re ducat <br /> 'Company; .NT 2� L <br /> Tele: ,":c, 2i-2, — 3 c 4 E-Mnll: <br /> Pro tet N: \\ l - - v Pro ect Nnme: =,,[4 <br /> Project Location: ? Purchase Order#\\- I ov a p ry 8 <br /> Sampler Siena <br /> SAMPLING MATRIX METIIOD c5 a _ 0 & 3 <br /> PRESERVED g 'tl a 0 <br /> SAMPLEID Location/ T <br /> d g R '�p s .g $ 9 <br /> FieldPal" <br /> a e a p $ ry <br /> Nerve <br /> 1� 8661 <br /> a � d � �taaaa <br /> �- 6+v Vic X — <br /> r' s S' 1 5 I O s c t ;,� "x _ <br /> 'ya <br /> "MAI client MVar disclose any dangerous chemicals known to be present In thelr submitted samples In concanhallom tial may cause Immedlale harm or mdom lulme hmlih endangerment or a result of btlU,gloved,open air,rumple <br /> handling by MM doll.Non•dlsdosaro InOuu an Immetllale$7 a0 Surcharge and the client n subject to lull legal IlabIIIM for harm suffered. thank you lot your undenlanding and for allowing us to work solely. <br /> ••'Ilmelals are re uested for walecramalts and the wales typels not r ectled an the choln of custodv.then MAI UId.f.uUJ2p!4lfby 1700.6. <br /> Rellnqulshed Ry: Date: Time: Received Dy;- _ __---- ICE/1• I I \- COMMENTS: <br /> ,�' ��/Cat✓, /:C-/I� L7HCi .� <br /> O <br /> VO <br /> READ SPACE ABSENT <br /> ReiingdlAnd By: Dale: Time: Received Ey: -- DECHLORINATED IN LAB <br /> APPROPRIATE CONTAINERS_ <br /> PRESERVED IN LAD_ <br /> Relinquished By: Date: Time: Received By: VOAS O&G METALS OTHER HAZARDOUS; <br /> PRESERVATION 1)1K2 <br /> Page 18 of 19 <br />
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