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ARCHIVED REPORTS_XR0005097
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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392
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3500 - Local Oversight Program
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PR0545570
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ARCHIVED REPORTS_XR0005097
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Entry Properties
Last modified
9/16/2020 1:58:48 AM
Creation date
3/18/2020 2:17:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005097
RECORD_ID
PR0545570
PE
3528
FACILITY_ID
FA0009389
FACILITY_NAME
SJC DEPT OF AG - MANTECA
STREET_NUMBER
392
Direction
S
STREET_NAME
MOFFAT
STREET_TYPE
BLVD
City
MANTECA
Zip
95336
APN
221-030-08
CURRENT_STATUS
02
SITE_LOCATION
392 S MOFFAT BLVD
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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720 Olive Drive, Suite D <br /> Davis, CA 95616 � � (�,] � - <br /> Lab 530 297 4800 �.�-1 <br /> Fax 530 297 4803 La o Page i of <br /> Prosect Contact(Hardcopy or PDF To) EDF Report? ❑ Yes ❑No <br /> Joe I�cq" U Chain-of-Custody Record and Analysis Request <br /> Company/Address Recanmendedbut not mandati togT le Us section <br /> P.k "u y e t`�I W ,r0y X e%'t r 0 Sampling Company Log Code F- <br /> PC t3�'� �c , Rivit.kc Mmrt�tN 9SU3 Analyses Request <br /> Phone No FAX No Global ID m x <br /> N ►- <br /> Q O N W <br /> Project Number PO No EDF Deliverable To(Email Address) �_ m o <br /> O W W N <br /> N 1- O <br /> Project Address Sa ler Signature o °-W�° m w o a <br /> Project Name _ - a a CQ <br /> Sampling Container reservative Matrix N o r N -J�roy <br /> Aq Mghtft�L, Q m (7 y O 0 w y T W" u0 N 0 <br /> W d Q m Cm = N r U- <br /> > W W W x ca m y N <br /> Designation Date Time a cJn = _ 0 z m m F 0 0 0 0 W J r <br /> 02-2C 1115 10 z ewe t X X X x X X 5[ Z <br /> GIS-25 Jcc t x x % x x 5i x <br /> Gr-12 4 X I I X X X W� x <br /> �r�i�2C t x x X x x X <br /> X X <br /> x x x x <br /> Gila - Ilia I x X 5[ X <br /> 1110 4 X X X x x X X [� x <br /> 1144 t X X x X x x � x <br /> 0.3 - 25 X X X % X <br /> Relinquished by Date Time Received by Remarks.Al t 4LO,', x'11 u -r L dd`G1� � �' 'Nf CAIS' <br /> Relinquished by Date Time Received by <br /> eu( 5 ,Xel <br /> Relinquished by Date Time Received by Laboratory Bili to Rio M43 V t Fly)w b N tM e q t <br /> V4- 13CA Ear`, 901140 M%4ii lh t to <br /> Distribution White-Lab Yellow-File Fink-Originator Forms/coc 121001 fh9 <br /> 1 <br />
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