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ARCHIVED REPORTS_XR0006641
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_XR0006641
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Entry Properties
Last modified
9/29/2020 10:21:30 PM
Creation date
8/5/2020 4:09:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006641
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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z <br /> Page of - <br /> Environmental 1.9wratory <br /> l�l 8880 Interchange Drive Analysis Request and Chain of Custody Record <br /> Houston,Texas 77054 <br /> 713/660-0901 - <br /> Project No Client/Project Name Project Location <br /> Field Date <br /> a Sample Sample r LABORATORY- - <br /> Sample No/ and E c Container Type(Liquid Pyr" ANALYSIS REUtJESTEp REMARKS- <br /> Identification Time is U (Siie/Ma1'l) Sludge Etc) votive - <br /> �F1� 3I F 13L40 e- -x is �x i%r Qu(0 met, A i Q Z o <br /> Se p rs (Signature) Ralinqulahad by Data �.L�-p) Received by . t h tv-�r� Date 4 intact - <br /> (Signature) (Signature) - <br /> Tirna /a3o Time _— <br /> Relinquishedbys, a✓k Date .%t s Received by Date intact- -- - — <br /> t,WAJ a L (Signature) (Signature) - _-- <br /> Affiliation Time 40<10 _ Time -— — <br /> Relrnquishad by Date Received by Date <br /> (Signature) (Signature) - =I <br /> Time Time <br /> SAMPLER REMARKS Received for labo tory Date S Laboratory No = _ <br /> (SfpnatureJ Time <br /> Data Res - <br /> Seal a =- <br />
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