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CO0054358 (2)
Environmental Health - Public
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2500 – Emergency Response Program
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CO0054358 (2)
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Entry Properties
Last modified
3/23/2022 2:23:28 PM
Creation date
3/23/2022 2:16:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO0054358
PE
2546
STREET_NUMBER
3350
Direction
S
STREET_NAME
ROBERTS
STREET_TYPE
RD
City
STOCKTON
Zip
95206
APN
16215005
ENTERED_DATE
10/11/2021 12:00:00 AM
SITE_LOCATION
3350 S ROBERTS RD
RECEIVED_DATE
10/11/2021 12:00:00 AM
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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SJGOV\ymoreno
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EHD - Public
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CASTLE ANALYTICAL LABORATORY L t 0,4 c.i 6_ 510e, CHAIN OF CUSTODY <br />"4.4 /ef tre. ELAP Certificate No. 2480 Location: 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 <br />eto/-c <br />Phone: 209 384-2930 - Fax: 209 500-1848 <br />Customer: P644_ SAMPLE TYPE composite(c) discrete/grab(d) SAMPLE MATRIX soil(s) liquid(I) vapor(v) other (0) REQUESTED ANALYSES NUMBER OF CONTAINERS II Method of Shipment: <br />Address: /1 e., /1 o K t if Y J IBTEX/MTBEJTPH-GAS 8021/8015 TPH-DIESEL / MOTOR OIL - 8015B [ TRPH 418.1M / SM5520C & F Oxy's / EDB / DCA by 8260 8260 Volatiles- full list PCBs - 8082 Electronic Deliverables (EDF) City/State/ZIP: ,4/c c 1.-5 e ....4,--: Notes: <br /> \O7 -33 <br />Phone / Email: 2,31 - -i.7 -7- e9c,--2-- F-25 t. <br />Project# / PO# / Global ID: P/s/ll'3,c,:,1-qL1(pt7q <br />Report Attention: <br />Sampler Signature: I? pli. <br />Sampler Printed: Printed: z_________:__ <br />Lab ID# SAMPLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />103 q's A ma 2 1 0 --)z , la :0 0 fr-c>rz--,6--., ---& 323Y c.iorie-r <br />rIFTivi qgz?zev /o./2-zr /Iv/ <br />Y6R4 <br />Signature Printed Name Date Time Company Name <br />Total number of containers <br />submitted to the laboratory <br />Relinquished by/t2,--/ k. <br />e <br />.c)c 5:, a eie lo•Iza (3:5-2 I. 1 (," ifi- Turn <br />24 <br />48 <br />3 <br />5 <br />Aroun Tinkell7 <br />Received by: ra iz--( i /Li (C7-e-, (.1,-dic-, (7 / - e ,-,1 k--17-2( i:,' :2- -7 c,c.--4-(-e ,,, ,/, Hour 0.3 <br />Relinquished by: Hour <br />Received by: Day <br />Relinquished by: Day (Normal) <br />Received by: Seecial: — <br />Mailing Address: 2333 Shuttle Drive, Atwater, CA 95301 PAGE OF
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