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FIELD DOCUMENTS_FILE 2
Environmental Health - Public
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EHD Program Facility Records by Street Name
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E
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88 (STATE ROUTE 88)
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13975
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2900 - Site Mitigation Program
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PR0522057
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FIELD DOCUMENTS_FILE 2
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Last modified
11/20/2024 9:21:41 AM
Creation date
9/5/2019 2:36:52 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 2
RECORD_ID
PR0522057
PE
2950
FACILITY_ID
FA0015024
FACILITY_NAME
USA GASOLINE #3756
STREET_NUMBER
13975
Direction
E
STREET_NAME
STATE ROUTE 88
City
LOCKEFORD
Zip
95237
APN
01908014
CURRENT_STATUS
01
SITE_LOCATION
13975 E HWY 88
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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C- XIN OF CUSTODY R :ten J <br /> SAMPLER (signature): <br /> A,ow/ie� GeoSystems <br /> Phone: `111c1�nn 31c(1 Suite irnmeuv. 1 1141)it? .:15' <br /> LABORATORY: SHIPPING INFORMATION : <br /> r,—'L SC S`�EV--5 Shipper <br /> 1 5 <br /> Address <br /> Date Stripped <br /> TURNAROUND TIME: y g �a�`� Service Used <br /> Attention: C,,-V+OW&A Ai-4 Airbiil No. Cooler No. <br /> Phone No. <br /> Refinquisned by. (signatures) Received by. (signatures) Date Tim <br /> Received tartpocratory by: <br /> LABORATORY SHOULD SIGN UPON RECEIPT AND RETURN A COPY OF THIS FORM WITH THE <br /> LABORATORY RESULTS <br /> Sample Site Date Analyses Sample Condition <br /> No. Identification Sampled Requested Upon Receipt <br /> 7' i V 14 t 3cF ?'x <br />
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