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CO0054834
Environmental Health - Public
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2500 – Emergency Response Program
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CO0054834
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Entry Properties
Last modified
11/19/2024 10:36:08 AM
Creation date
8/3/2023 9:54:30 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2500 – Emergency Response Program
RECORD_ID
CO0054834
PE
2546
STREET_NUMBER
0
Direction
S
STREET_NAME
I-5
City
LATHROP
Zip
95330
APN
NEAR 19125014
ENTERED_DATE
4/21/2022 12:00:00 AM
SITE_LOCATION
SOUTH BOUND 5 AT ROTH ROAD
RECEIVED_DATE
4/21/2022 12:00:00 AM
P_LOCATION
99
P_DISTRICT
003
QC Status
Approved
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SJGOV\bmascaro
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EHD - Public
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PAGE / OF ( <br />CHAIN OF CUSTODY CASTLE ANALYTICAL LABORATORY <br />Location: 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 <br />Mailing Address: 2333 Shuttle Drive, Atwater, CA 95301 <br />Phnne (2091 - - Fax•500-1848 <br />a <br />ELAP Certificate No. 2480 <br />Customer: -,,/ ,/,f0f ri I SAMPLE TYPE composite(c) discrete/grab(d) SAMPLE MATRIX soil(s) liquid(I) vapor(v) other (o) REQUESTED ANALYSES NUMBER OF CONTAINERS Method of Shipment: <br />Address: Q3:7)i1TBE/TPH-GAS 8021/8015 TPH-DIESEL / MOTOR OIL - 8015B TRPH 418 1M / SM5520C & F Oxy's / EDB / DCA by 8260 I 8260 Volatiles- full list PCBs - 8082 Electronic Deliverables (EDF) City/State/ZIP: Notes: <br />Phone / Email: <br />Project# / PO# / Global ID: 0 Qs, c <br />Report Attention: <br />Sampler Signature: 1 . <br />Sampler Printed: ti/Vd „tiz7/7 ..V/ <br />Lab ID# SAMPLE ID DAT TIME DESCRIPTION/LOCATION OBSERVATIONS/REMARKS <br />efit7k4A/5 2‘7 71 /03e7//v) (24C-6470 /0 <br />Signature Printed Name D te Time Company Name <br />Total number of containers <br />submitted to the laboratory <br />Relinquished,by: A ,11W, g- (/ : _/), 5 U• Z rd Turn Around Time: <br />._ Received by: ila --- <br />(..- A______ ; ‘-1 .7e 6-74Le, 24 Hour _ r• <br />Relinquished by: 48 <br />3 <br />Hour I I <br />Received by: Day I <br />Relinquished by: 5 Day (Normal) ii.,.....L <br />Special: Received by:
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