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CO0054647 (2)
Environmental Health - Public
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2500 – Emergency Response Program
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CO0054647 (2)
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Last modified
3/23/2022 2:33:34 PM
Creation date
3/23/2022 2:28:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO0054647
PE
2546
FACILITY_NAME
RESIDENTIAL
STREET_NUMBER
3916
STREET_NAME
PINE LAKE
STREET_TYPE
CIR
City
STOCKTON
Zip
95219
APN
11646023
ENTERED_DATE
1/28/2022 12:00:00 AM
SITE_LOCATION
3916 PINE LAKE CIRCLE
RECEIVED_DATE
1/28/2022 12:00:00 AM
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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CASTLE ANALYTICAL LABORATORY CHAIN OF CUSTODY <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 />Certificate No. 2480 <br />PAGE OF \ <br /> <br />Customer: PG&E Stockton SAMPLE TYPE composite(c) discrete/grab(d) SAMPLE MATRIX soil(s) liquid(l) vapor(v) other (o) REQUESTED ANALYSES NUMBER OF CONTAINERS Method of Shipment: <br />TA; l._,‘ 0 Address: 4040 West Lane BTEX/MTBETTPH-GAS 8021/8015 TPH-DIESEL - 8015 TRPH 4181M / SM5520C & F OxIls / EDB / DCA by 8260 = = <br />Q <br />CD <br />CN <br />09 PCBs - 8082 Electronic Deliverables (EDF) City/State/ZIP: Stockton, CA 95204 Notes: <br />TOIA4 on-0 OLA_.) <br />Phone / FAX: (209) 942-1401 <br />Proj# / PO# /Global ID:e,j)\.:.; t_ j 6 CV-1_ <br />Report Attention: Alexpele / v arsen <br />Sampler Signature: <br /> <br />Sampler Printed: CY:\Oklr l.-,N2 &-",::), ) <br />Lab ID# SAMPLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />uwe cif? 4 -r) .7 L 12 U0 02_ 0, L_ / \ <br />Printed Name Date Time Company Name <br />TsuotbamTttuemdbtoerthoef containers <br />//%____ Signature <br />Relinquished by: Z"--,-, <br />, <br />Cf\LX-; LAZ,St5Li "?.9 -Z2 t S- PC, E, Turn Around Time: <br />Received by: 24 Hour ir <br />Relinquished by: 48 <br />3 <br />5 <br />Hour I I <br />Received by: Day I <br />Relinquished by: Day (Normal) I I <br />Special: Received by:
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