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ARCHIVED REPORTS_XR0007136
Environmental Health - Public
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EHD Program Facility Records by Street Name
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88 (STATE ROUTE 88)
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14000
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3500 - Local Oversight Program
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PR0544811
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ARCHIVED REPORTS_XR0007136
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Entry Properties
Last modified
11/20/2024 9:21:18 AM
Creation date
9/5/2019 1:43:07 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007136
RECORD_ID
PR0544811
PE
3528
FACILITY_ID
FA0000091
FACILITY_NAME
Colonial Energy CE 40138 (DBA Power Mart)
STREET_NUMBER
14000
Direction
E
STREET_NAME
STATE ROUTE 88
City
LOCKEFORD
Zip
95237
CURRENT_STATUS
02
SITE_LOCATION
14000 E HWY 88
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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I <br /> Chain-of Custodv Number 1.,� Z <br /> SECO Chain-of Custody Record &L11 _, <br /> Field Office A77 <br /> Additional documents are attached! and are a p <br /> Address Job Name f II <br /> 41 II Location <br /> II II <br /> Projectr# 37. cO6cO6�fask# II Analysis Request II <br /> Project Manager � �, <br /> Laboratory .- <br /> Tumaround Time a m En <br /> e <br /> a � � m V� O <br /> q m CV R O� m <br /> Sampler's Na a r�s.�� a'a T , P_ m m� a 0 <br /> Sampler's Sign ao O <br /> E� mN Wp 1N row i <br /> _ N <br /> Sample ID U Y� Z E `—°Q �� s=ins rn� m� o: 2 k <br /> Qate Time Matnx = w (Z� > =0 0(D a� F^ a� � Comments/ <br /> fL 7C I� OL Instructions z <br /> 9tir <br /> ,wUo !I z <br /> X x " �. <br /> II to <br /> A <br /> x II <br /> � F li <br /> Special Instructions/Comments <br /> Relinquishd by Received b I[ Sample Recei t <br /> r>� ,nom *Jp7 -rffw� f '61, '1 SE n y <br /> g. ign <br /> Print_ � Total no of containers <br /> /} � � nn# <br /> ��Or �t�J�►t J Company II F Chain of custody seals <br /> Company Rec'd ing ood condition/cold <br /> Time � Date 7 zTime <br /> II Conforms to record <br /> Relinquished by Receiv <br /> Sign II Sign Client .5eece _ <br /> Print II <br /> Company II Print — i liens Contactf� " <br /> i <br /> Company <br /> Time <br /> SECORCWTFiEC Rev 299 Date— Time_i35 ` Date Z ICliern Phone -0400 <br /> it <br /> S • Date a�_ Pag �Ofa <br /> u <br />
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