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CO7UMI7FZ
Environmental Health - Public
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EHD Program Facility Records by Street Name
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WIDMER
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1795
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2500 – Emergency Response Program
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CO7UMI7FZ
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Entry Properties
Last modified
4/27/2023 4:19:57 PM
Creation date
4/27/2023 3:59:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO7UMI7FZ
PE
2546
FACILITY_NAME
1795 W WIDMER LN
STREET_NUMBER
1795
STREET_NAME
WIDMER
STREET_TYPE
LN
City
MANTECA
Zip
95336
APN
20237050
ENTERED_DATE
12/11/2022 12:00:00 AM
SITE_LOCATION
1795 W WIDMER LN MANTECA CA 95336
RECEIVED_DATE
12/11/2022 12:00:00 AM
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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Lc_ <br />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 1 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 INUMBER OF CONTAINERS II Method of Shipment: r <br />Address: 4040 West Lane BTEX/MTBETTPH-GAS 8021/8015] TPH-DIESEL - 8015 TRPH 418 1M / SM5520C & F Oni's / EDB / DCA by 8260 7,7; <br />cp co o, <br />CO PCBs - 8082 Electronic Deliverables (EDF) City/State/ZIP: Stockton, CA 95204 Notes: 2 ,„ HI cz <br />(2u -i- (2u <br />Phone / FAX: (209) 942-1401 <br />Proj# / PO# /Global ID (Ai k ink(4, Ll.....)/ li k.--,-).\I \ 2_ <br />Report Attention: Alex Steele / a Larsen <br />Sampler Signature: <br />Sampler Printed: 140A - --- <br />Lab ID# SAMPLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />Lk) i OfV\A--;CL L1.3 lz -12:22 (6'.00 ti 0 2 (D % (-- V 1 <br />14(")\) 1/ ('P'%‘‘ 12-i2-22, toloo <br />(2 6 43 \‘ 17.12 -22 k D'ALD I 02_ c . L v- I <br />t-,:t k r-2_ fle__'" t?-17 -?2 I 0! 20 10? cAL v i <br />i <br />/ Signature Printed Name Date Time Company Name 1-1 <br />Total number of containers <br />submitted to the laboratory <br />Relinquished by: se..o90/C VANDO \...A112 (—,E1L—) i?,.1,422.2.s_3.) Pe.,-. Turn <br />24 <br />48 <br />3 <br />5 <br />Around Time: <br />Received by: 1 q A I-Vt.-1 (1 , t C, ir r .0, 0 , 12 ,14,7zPP.30 C 0—cf-1 -4, 1)The,P,i,r,0 Hour <br />Relinquished by: Hour I I <br />Received by: Day I <br />Relinquished by: Day (Normal) I 1 <br />Special: Received by:
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