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COJFFCKNO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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21657
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2500 – Emergency Response Program
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COJFFCKNO
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Entry Properties
Last modified
7/11/2023 2:43:36 PM
Creation date
7/11/2023 1:35:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
COJFFCKNO
PE
2546
STREET_NUMBER
21657
Direction
E
STREET_NAME
DODDS
STREET_TYPE
RD
City
ESCALON
Zip
95320
APN
20520005
ENTERED_DATE
4/13/2021 12:00:00 AM
SITE_LOCATION
21657 E DODDS RD
RECEIVED_DATE
4/13/2021 12:00:00 AM
P_LOCATION
06
P_DISTRICT
004
QC Status
Approved
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SJGOV\bmascaro
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EHD - Public
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LA, <br />- <br />CASTLE ANALYTICAL LABORATORY <br /> <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 />,nn • - <br />Certificate No 2480 <br /> <br />PAGE k OF <br /> <br />Customer: PG&E Stockton SAMPLE TYPE composlte(c) discrete/grab(d) SAMPLE MATRIX soil(s) vapor(v) other (o) REQUESTED ANALYSES NUMBER OF CONTAINERS Method of Shipment: <br />Address: 4040 West Lane BTEX/MTBE/TPH-GAS 8021/8015 TPH-DIESEL - 8015 TRPH 418 1M / 5M5520C & F Oxy's / EDB / DCA by 8260 76 — <br />c, . 1 PCBs - 8082 Electronic Deliverables (EDF) City/State/ZIP: Stockton, CA 95204 Notes. <br />7 R <br />4i2 us \--1 <br />Phone / FAX: (209) 942-1401 •1 <br />Proj# / PO# /Global ID: ' a , _LP) 0 oc0 --, 1 &)\ <br />Report Attention: Alex Stee Wave Larsen (.1 <br />.p..!,/,' Sampler Signature: /:/ <br />Sampler Printed: <br />Lab ID# Lab SAI4PLE ID DATE TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />LA-t?-21 r1'.00 \ 02 C-.) i l--, <br />75 : CZ- <br />_ <br />_ - <br />n <br />:!...- <br />fora! number of containers <br />submitted to the laboratory Signature -/ Printed Name _ Date Time Company Name <br />.--7 _,/ <br />Relinquished by by: e>„(-Arie: . .'"------------ °NYE ULISer--_,L=. L.) '-i n-21 PC,: E: Turn <br />24 <br />48 <br />3 <br />5 <br />Around Time: <br />Hour <br />Hour I <br />Received by: F74-1-:<,-,4-7 ,‘Ii-- Xii,;2 'ill- II 7 lcvi <br />Relinquished by: <br />Day I I <br />Day (Normal) I I <br />Received by: <br />Relinquished by: <br />Special: 2.- Vt2, Received by:
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