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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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SUTTENFIELD
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24876
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3000 – Underground Injection Control Program
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PR0519201
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Last modified
5/21/2020 11:21:43 AM
Creation date
5/21/2020 11:09:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3000 – Underground Injection Control Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0519201
PE
3030
FACILITY_ID
FA0014356
FACILITY_NAME
MILLER RES UIC DRUG LAB
STREET_NUMBER
24876
Direction
N
STREET_NAME
SUTTENFIELD
STREET_TYPE
RD
City
ACAMPO
Zip
95220
CURRENT_STATUS
02
SITE_LOCATION
24876 N SUTTENFIELD RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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GeoAnalytical Laboratories, Inc. Lab Report#_ J - I2 _ <br /> 1405 Kansas Avenue, State "A" Phone: (209) 572-0900 Regulatory CJ Yes ❑ No CC: ❑ Yes ❑ No <br /> Modesto,CA 95351 Fax: (209) 572-0916 Regulator: <br /> Phone: (2_001) <br /> Client: _ 0{A ��r�� �'��-P2l�p iSF _ CHAIN OF CUSTODY Fax: {f } �f 7 <br /> Address 3 t✓ Original To: T? r0 n LlC'CC.I'}e <br /> City !bc Zip �� l '-t �� Reporting: ❑ EDF ❑ EDT <br /> r Project 1D la r f U o _Lab Use Only <br /> r (Print Frame) <br /> Sampled By '1 � 1 ' t Lick-l <br /> (Signature) r ° y � <br /> ` Containe <br /> Sample type Sample ID z Lab ID# <br /> � <br /> Date Time Grab Comp Matrix Type Size �! p.i <br /> L!I 0 - X X Rernarksi I V 5� q S <br /> iZ l�-C2 ( �r L x 2_q 4-0 <br /> Remarks <br /> ! RelinDate Time Received Y(Signature) 1 ` 2 tDate Time <br /> 't, Ict <br /> Relinquis ed y( ignature) Date Time Recei ed (Signature) Date Time <br /> Preservative Matrix <br /> 0-4°C 0-HCL ()-NaOH 0-Na2S203 0-HNO3 19-H2 S 04 Q-0ther Drinking Water QWaste Water®Hazardous Waste (Water) ©SoiVSoiid <br /> Site Time: Time Mileage <br /> Drivin Time: � <br /> Start: O" (/ Finish: �.��SS Total Hours: ��5tart: g / Arriva i x2=Tata1: <br /> [T.M.-ndTime ❑Standard OSifver Rush QGold Rush /8 annum Rush E]Otber. Approved By: ���,� <br />
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