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Environmental Health - Public
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2900 - Site Mitigation Program
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PR0538738
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Last modified
2/6/2020 10:20:26 AM
Creation date
2/6/2020 9:20:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0538738
PE
2950
FACILITY_ID
FA0022243
FACILITY_NAME
NEIL O ANDERSON & ASSOC INC
STREET_NUMBER
902
STREET_NAME
INDUSTRIAL
STREET_TYPE
WAY
City
LODI
Zip
95240
CURRENT_STATUS
01
SITE_LOCATION
902 INDUSTRIAL WAY
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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O � McCampbell Analytical, Inc. CHAIN OF CUSTODY RECORD <br /> 1534 Willow Pass Rd./Pittsburg,Co.94565-1701 II,RN AROUND TIME:RUSH 24HRQ481-1RQ72 IIR 015 DAY _ IUDAY 0 <br /> 1 <br /> www.mccompbell.com/ main@?mccampbell.com Georrackcr EDFQ PDF[, MDQ Wrile On(DW)[3 EQidSQ <br /> Telephone: (877) 252-9262/Fax: (925) 252-9269 <br /> F,ilinent Sample Requiring"J"BugQ UST Clean Up Fund Project Q;Claim h <br /> Ro mri"ro; Bill To: Analysis Request �= <br /> Com sally. ' C <br /> n <br /> E-Mail: i4 c — <br /> Tele: Fax: <br /> Project M: Project Name: <br /> Project Location: Purchase OrderH F v E s J rg $ g <br /> Sarn ler Signature: — E _` < D o ba a g S e <br /> e. • <br /> MATRIX METHOD V <br /> SAIIPLING PRF.SERVF.D <br /> V $ 7 ne L 'Gr <br /> SAMPLEID Lomtlms! e : >' ` ? E 8 a — _ e 5: <br /> Field Poles > . a E. 2 E y `3 — ry n e 2 R, S E <br /> Date c $ n tName � <br /> O <br /> ae V C r n < a <br /> x 3: 56 IQ <br /> — <br /> 1_ = .y <br /> k _ 3Q <br /> H� <br /> • <br /> '-MAI clients MUST dhclmc any dangerous chemicals knon a to Le present In their submined samples in conmalr etbm,that may cunse immcdiata harm or serious ratnrc 11"llb endangerment m u.null of brkf, <br /> glmnl,oprn air,sample handling by MAI nott.flon disclosurc incurs an immediate5250 sorchorae and the client b.abicct to run leaal liability for harm%uttered. Thank you for year understanding and for allowing <br /> M to mark safely. <br /> Rellagnbhed By: nate: Time: d ICFIr' COMMENTS: <br /> j• t:'� GOOD CONDITION_ Sam?)1 �U--Sll .. <br /> �7l HEAD SPACE ABSENT_ <br /> Relinque d Bate: Time: ci d By: DECHLORINATED IN LAB_ rrt <br /> j APPROPRIATE CONTAINERS_ `�u�l) <br /> 2 PRESERVED IT LAB_ <br /> Rcli bad By: ole: Time: IWIL o Id III VOAS OBG METALS OTHER HAZARDOUS: 17 <br /> PRESERVATION III- <br /> 2-Page 78 of 79 <br />
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