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Environmental Health - Public
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3500 - Local Oversight Program
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PR0545209
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Last modified
1/27/2020 5:07:37 PM
Creation date
1/27/2020 4:24:39 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545209
PE
3528
FACILITY_ID
FA0003963
FACILITY_NAME
TRACY76
STREET_NUMBER
2420
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
Tracy
Zip
95377
APN
23802006
CURRENT_STATUS
02
SITE_LOCATION
2420 W GRANT LINE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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ti <br /> r Chain of Cost Number-, 3" <br /> -6 .t <br /> SECOR' Chalk-of Custody Record <br /> N <br /> m <br /> Field Office: 077 Sacramento AFM Additional documents are attached, and are part of this Renard. w <br /> Address: 3017 VJ Road,Suite 100 .lob Name: 7-Eleven Store#32282 I , <br /> Rancho Cordova.CA Location: 2380 West Grant Lina Road <br /> Tracy,CA <br /> Project# 77EL.32262.03 Task# 0410 Analysts Request <br /> LO <br /> Project Manager Jaff Auchtsrlonlle <br /> Laboratory I(Iff Arfalytical _ OD <br /> Turnaround Tirne Standard C'M Sampler's Name Toni Miller � �5E � � ��� � n <br /> Sampler's Signature A K3 <br /> U!E - I <br /> 1111Ma <br /> Sample It] Date Time Matrnr 2 $ g <br /> $ tnstructtons <br /> MW-1 rgK . x. X-1 I x I 1 3- 01 <br /> MW-2 x x x 3 OL. <br /> MW-3 x % x 3 05 <br /> MW4 x x x 3 CJ%i U3 <br /> MW_'i x X X 3 Q g n <br /> MW-40 D x x x 3 to X <br /> pedal InstructionslComments id b : Received by: Sample Receipt <br /> 5 Oxygenates:TAME,MtBI:,ELBE,TBA,DIPE sign Sign Total no.of containem: <br /> Global ID ffTOb07729562(SIRC) Print ,1hLl a4 4, PrInt Ch aln of custodyr aaais: <br /> EDF Dethwables(small EDF to dacaitlln@secar.com) CompanY t [=- f C ny Reed in good cond&nfcold: <br /> email tab results to dhm7ogiMsemr.com Time Date ime hate Cwfanns Go record: <br /> Relfrtquished by: Rete' D . <br /> Sig" Sign Client: SECOR <br /> Print Print — Client Contac,(: Brian caret' I> <br /> Co y Camgeny Tit Phone: 818 881-0+400 m <br /> e bete Time 6RC45 _Date—UM o� ext 241 <br /> anooewamec iwr.au _ - r� <br /> V <br /> j <br />
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