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COIS4DASJ (3)
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4 (STATE ROUTE 4)
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22510
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2500 – Emergency Response Program
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COIS4DASJ (3)
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Entry Properties
Last modified
11/20/2024 9:09:12 AM
Creation date
3/23/2022 3:00:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COIS4DASJ
PE
2546
STREET_NUMBER
22510
Direction
E
STREET_NAME
STATE ROUTE 4
City
STOCKTON
Zip
95215
APN
18334001
ENTERED_DATE
8/14/2021 12:00:00 AM
SITE_LOCATION
HWY 4 & HEWITT RD
RECEIVED_DATE
8/14/2021 12:00:00 AM
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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CASTLE ANALYTICAL LABORATORY <br />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 t OF <br /> <br />Customer: PG&E Stockton SAMPLE TYPE composite(c) discrete/grab(d) SAMPLE MATRIX soil(s) liquid(I) vapor(v) other (o) REQUESTED ANALYSES Method of Shipment: <br />Address: 4040 West Lane BTEX/MTBE/TPH-GAS 8021/8015 TPH-DIESEL -8015 TRPH 418.1M / SM5520C & F Oxy's EDB / DCA by 8260 PCBs - 8082 Electronic Deliverables (EDF) I 0 <br />City/State/ZIP: Stockton, CA 95204 <br />= <br />c> cc, c.i <br />Lii z ITc <br />z <br />0 <br />u_ <br />cc' Lii <br />CO 2 D z <br />Notes: <br />J CA-075-0 <br />Phone / FAX: (209) 942-1401 <br />Proj# / PO# /Global ID: <br />Report Attention: Attention: Alex Steele /. .),/e. Larsen <br />Sampler Signature: <br />Sampler Printed: ();--- ZA-956L) <br />Lab ID# SAMPLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />17\64)i cc— (2a <.t -t4-171 Cr.(a) t 02_ cYiL__ i/F ) <br /> _ <br />_ <br />_ <br />_ <br />Signature Printed Name Date Time Company Name ‘ <br />Total number of containers <br />submitted to the laboratory <br />Relinquished by 44,0-7.-4C— Dave Larsen 61(z, 2( 2,i t PG&E Turn Around Time: <br />ei f iP .3_-' ii Cf,„_--f--_ 24 Hour Received by: 4..-Q,:---,c_.-0 6-7_,..A.—A--•--- ft;e--1--Y-) C-A--0 gril-L-L-4--*/ <br />Relinquished yi._,,, 48 Hour I <br />Received by: 3 Day I I <br />Relinquished by: 5 Day (Normal) I I <br />Received by: Special:
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