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ARCHIVED REPORTS_XR0006492
Environmental Health - Public
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EHD Program Facility Records by Street Name
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Y
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YOSEMITE
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1012
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3500 - Local Oversight Program
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PR0545948
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ARCHIVED REPORTS_XR0006492
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Entry Properties
Last modified
9/29/2020 10:17:19 PM
Creation date
8/5/2020 3:53:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006492
RECORD_ID
PR0545948
PE
3528
FACILITY_ID
FA0005159
FACILITY_NAME
FILL-EM FAST
STREET_NUMBER
1012
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
21903024
CURRENT_STATUS
02
SITE_LOCATION
1012 W YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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LSauers
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EHD - Public
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Chain of Cindy Record <br /> ��(� Dale /< 3/�'�0_) <br /> 148 S Vlnewood St Escondido, CA 92029•ph 760 735 3208*fax 760 735 2469 ;C <br /> HPL Project# �S-x"`-01 U -— <br /> _ ® 432 N Cedros Ave, Solana Beach, CA 92075•ph 858 793 0401 •fax 858 793 0404 <br /> L1�$wS 0 2373 208th Street Unit F-1,Torrance, CA 90501 •ph 310 782 2929•fax 310 782 2798 Outside Lab <br /> Client 14TZ 14SSdLC Collector / 41<_dt- l Page / Df <br /> Address � e3A���'e �� Z�-9 Client Protect# y3 25 rz7 DOLS Project Manager <br /> LocationySF_Rr//r <br /> -Phone 3�57-SCc`7- OtQ-754 g�$ r S4 9 r g� Turn around time <br /> Notes _ ^1 826OB Sample Receipt <br /> o <br /> �✓L r s E 8 o Intact ❑Yes ❑No <br /> _ 8 w b 2 <br /> w m Seal Intact ❑Yes Q No ❑NIA <br /> X T Cold ❑Yes❑No <br /> w o o y <br /> - m a N J NIA(Received on Site) v <br /> -- m of m c co 0 <br /> ani a o F m m m is <br /> Sample Container = <br /> — y <br /> Sample Depth Time JDate �TJype� Type F o o W li Field Notes F <br /> vDA5 r'Q <br /> 0I <br /> 3 /44/_- IZ'3o <br /> --y MA/ <br /> 7 e7w7 Jz YO <br /> =4 w-Y i »'5.3 <br /> Relingwshe y Signat e) (company) Re d by (SignTime <br /> at (co pan ) Date me <br /> l�TG �S <br /> Rel q sh Q by {Si ( mpa y) Receiv (company) Die 1 j D Z Time <br /> Ra LAqu alure (company) Received by (Si atu (company) Date (/ Tim <br /> Signature constitutes authorization to proceed with analysis and acceptance of condition on hack Sample disposal instruction Q Disposal @$2 00 each Q Retum to client 0 Pickup <br />
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