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SR0082895_SSCR
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2600 - Land Use Program
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SR0082895_SSCR
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Entry Properties
Last modified
12/3/2020 2:10:21 PM
Creation date
12/3/2020 9:16:42 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSCR
RECORD_ID
SR0082895
PE
2603
STREET_NUMBER
23577
Direction
S
STREET_NAME
MOUNTAIN HOUSE
STREET_TYPE
PKWY
City
MOUNTAIN HOUSE
Zip
95304
APN
20908026
ENTERED_DATE
11/16/2020 12:00:00 AM
SITE_LOCATION
23577 S MOUNTAIN HOUSE PKWY
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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SJGOV\sshih
Tags
EHD - Public
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SunStar <br /> Laboratories, Inc. Chain of Custody Record <br /> PROVIDING QUALITY ANALYTICAL SERVICES NATIONWIDE <br /> 25712 Commercentre Drive, Lake Forest, CA 92630 <br /> 949-297-5020 I <br /> Client: �e�� <br /> �.c a.� Cuv+��,� „ts Date: 12' 13`t Page: Of <br /> Address: 'loZ- Project Name: <br /> Phone: ?_o ff�(� j-1� 1 v 1 ax: Collector:Y� �; .u�� s Client Project#: <br /> Project Manager: �� 1�►�•Eat�il.� Batch#: 9y3rb EDF#: <br /> L/J O N <br /> pO <br /> O <br /> W <br /> M c_ L OXX xNXO <br /> O LLJ LU orL <br /> I W O OO <br /> t LO CO I\ U (6 <br /> DateSample... ._-Confainer �. ..� ....C, o N � � � °. <br /> Sample ID Sampled Time Type Type w w � w w w w w (D ( ® J Comments/Preservative � <br /> 1C 0'IG L �sl�ss 6 <br /> f 3^- to 12 13.1 1 U:t5 .,, ®2 in ic•c S 7 <br /> t3= Wi I 0*,qT - tee$ 61 �S <br /> 17. 13,101 11"1'3 __ 07- i <br /> 4— �� IL 13, "1 11 iO n "v 0' <br /> St3 1`t ^ 17.12" 1Gi 12'•33' vJ©2- 6-tic-&S 22 <br /> �t3 1� s�� ��, •3. 1`1 t'-� .� `� a lis 23 <br /> S1 &1- v� z <br /> Relinquished by: (signature) Date/Time Ree, zd by: (si ature) Date/Time v Total#of containers N t/e�s <br /> i1�'int°i� 1,'•cxe, ` `� Chain of Custody seal /NA <br /> Re uished by: ignature) Date/Time eceiv d (signature) Date/Time Seals intact? N/NA <br /> Received good condition/cold 6( f <br /> Gs'a (2-rr-r. � �.� � i � /2- gig 10.3 9 N• <br /> Relinquished by: (signature) Date/Time Record by: (signature) Date/Time <br /> Turn around time: <br /> Sample disposal Instructions: Disposal @$2.00 each Return to client Pickup <br /> COC 160006 <br />
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