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ARCHIVED REPORTS_XR0005116
Environmental Health - Public
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EHD Program Facility Records by Street Name
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M
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MOFFAT
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229
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3500 - Local Oversight Program
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PR0545566
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ARCHIVED REPORTS_XR0005116
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Entry Properties
Last modified
9/23/2020 10:41:34 PM
Creation date
3/17/2020 4:41:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005116
RECORD_ID
PR0545566
PE
3528
FACILITY_ID
FA0005479
FACILITY_NAME
MANTECA BEAN CO
STREET_NUMBER
229
STREET_NAME
MOFFAT
STREET_TYPE
BLVD
City
MANTECA
Zip
95336
CURRENT_STATUS
02
SITE_LOCATION
229 MOFFAT BLVD
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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----- 4080 PIKE LANE, SUITE C CHAIN-OF-CUSTODY RECORD <br /> CONCORD CA 94520 33526 <br /> GT E L (510 685-7852 AND ANALYSIS REQUEST <br /> N90PAI..." .0 (800;423-7143 IV MIA; <br /> r <br /> Company Name Phone # (5110) 671 ` ;L319 <br /> —T_ft Yto Sh FAX# 1 fin— /Y� ❑ ❑ 0 <br /> Company Address Site LocationLu CD <br /> itOS`7 Port Ckt('3eNNy a�oj �]oa<fi t ,d�vr� r v ❑ ¢ ❑ <br /> rr o <br /> 7 <br /> ❑ 7 ❑ ❑ y 5 a o <br /> Cv In C Y D crn (c, o �, �, p a 0 `° ❑ <br /> Protect Manager Chent Protect ID (#) n�Y0 1-7c - ±75 2 ❑ a ❑ <br /> I y� ❑ � U) cn ¢ F N <br /> Y1 O e SOC 1& Iv- G3c� m o A ❑ � ❑ z z p d ❑ m <br /> I attest that the proper field sampling Sampler Name (Print) ❑ S 7�Ell ❑ ❑ co> 0 El <br /> U cc procedures were used during the ,�y� f /� l r m © m ¢ ¢ in' ' w ❑ <br /> collection of these samples //l�{j![ C t yr ❑ CD 9 N ❑ ❑ C © n `� s <br /> ❑ v n_ o ` o v ^ a ¢ ❑ a <br /> Matrix Method Sampling o o a ¢ Q `°` °° ❑ o o g <br /> Preserved a v ❑ w d d o ❑ ❑ m g Q <br /> Field GTEL z ❑ _ p� a ❑ w w m a ii y H ❑ m ❑ <br /> 9 N m <br /> Sample Lab# a u, o Q ❑_ ❑ ❑ a a ❑ <br /> F d 7 CL Q �p C'3 N O O O N N X V <br /> 1D Lab Usel w J fl 0 w p w°w w w w X o c Ln co co m m ro m O a Q <br /> only J a o � � r� i "' zw ¢ r a a o a a a a a� a a a U a ¢ B pp <br /> a to ¢ m a 0 x z z U O D t= m m = = Q' F w w w w w w w w w F w U d c� <br /> Mw--6 or I <br /> u._3 ✓ I y / <br /> �Ylw- OS" <br /> } <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS of <br /> Priority(24 hr) ❑ GTEL Contact I5 <br /> r <br /> Expedited(48 hr) ❑ Quote/Contract# Qc 9 301 O) <br /> 7 Business Days Q Confirmation# <br /> Qther <br /> Business Days ❑ PO # SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot# Storage Location <br /> QA/QC Level + <br /> Blue❑ CLP❑ Other❑ Work Order# <br /> Relinquished by Sampler Dat Time Received by <br /> CUSTODY a a219 <br /> FAX❑ -) 1 <br /> RECORD Relinquished by Date Time Received by <br /> Relinquished by0Dat Time Received by tory <br /> % 7•`�c� 1 Waybill# i <br />
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