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CO6QVK53B (2)
Environmental Health - Public
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2500 – Emergency Response Program
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CO6QVK53B (2)
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Last modified
2/8/2022 1:30:28 PM
Creation date
2/8/2022 1:26:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO6QVK53B
PE
2546
STREET_NUMBER
1813
STREET_NAME
MOFFAT
STREET_TYPE
BLVD
City
MANTECA
Zip
95336
APN
22805005
ENTERED_DATE
9/8/2021 12:00:00 AM
SITE_LOCATION
1813 MOFFAT BLVD, MANTECA, CA 95336
RECEIVED_DATE
9/8/2021 12:00:00 AM
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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CASTLE ANALYTICAL LABORATORY <br />Location: 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 <br />Mailing Address: 2333 Shuttle Drive, Atwater, CA 95301 <br />Phone: (209) 384-2930 - Fax: (209) 500-1848 <br /> <br />CHAIN OF CUSTODY <br />PAGE_I_OF <br /> <br />Certificate No. 2480 <br /> <br />Customer: PG&E Stockton SAMPLE TYPE composite(c) discrete/grab(d) SAMPLE MATRIX soil(s) liquid(1) vapor(v) other (o) REQUESTED ANALYSES NUMBER OF CONTAINERS Method of Shipment: <br />0 -C-k_ iooR_cci Address: 4040 West Lane BTEX/MTBE/TPH-GAS 8021/8015 TPH-DIESEL -8015 TRPH 418.1M / SM5520C & F Oxys EDB / DCA by 8260 8260 - full list PCBs - 8082 Electronic Deliverables (EDF) City/State/ZIP: Stockton, CA 95204 Notes: <br />Phone / FAX: (209) 942-1401 <br />Proj# / PO# /Global ID: iqi ---; Ak ccrA-7 \tic\ <br />Report Attention: Alex Steele Da Larsen <br />V Sampler Signature:Signature: 61 ! <br />Sampler Printed: 10A ()-- ( f<Qs4513 <br />Lab ID# SAMPLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />A 61 -15-2( L1r5o 1 02 oic_ v t <br />B <br />g-ZI 51(z) I 0,2_ OIL y' I <br />D 1-51-21 &IC) t c:)2_ C7‘1--, iv 1 <br />Signature Printed Name Date Time Company Name <br />Li Total number of containers <br />submitted to the laboratory <br />Relinquished by: geoliX-ga.„4.- tON-X" (.AQ-L) 9-152) Pa.i o Turn Around Time: <br />24 Hour <br />48 Hour [ I <br />3 Day I <br />5 Day (Normal) <br />Special: <br />Received by:1'11 A6 q-gi 1441 <br />Relinquished by: by: _ <br />Received by: <br />Relinquished by: <br />Received by:
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