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COMPLIANCE INFO_2023 DOMESTIC WELL SAMPLING
Environmental Health - Public
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EHD Program Facility Records by Street Name
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4400 - Solid Waste Program
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PR0440005
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COMPLIANCE INFO_2023 DOMESTIC WELL SAMPLING
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Entry Properties
Last modified
11/14/2023 4:26:31 AM
Creation date
11/13/2023 2:13:14 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4400 - Solid Waste Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023 DOMESTIC WELL SAMPLING
RECORD_ID
PR0440005
PE
4433
FACILITY_ID
FA0004516
FACILITY_NAME
FORWARD DISPOSAL SITE
STREET_NUMBER
9999
STREET_NAME
AUSTIN
STREET_TYPE
RD
City
MANTECA
Zip
95336
APN
20106001-3, 5
CURRENT_STATUS
01
SITE_LOCATION
9999 AUSTIN RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\cfield
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EHD - Public
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ENYIRCNMENTA!BCIEHCES <br /> Chain of Custody and Cooler Receipt Form for 2317699 Page 2 of 2 <br /> PACI:ANALYTICAL C011 RECEIPT FORM Pri — <br /> S ubmisslort#_ 2-3-J <br /> SHIPPING INFORMATION SHINNING CONTALINFR ll QUID <br /> Fod Ex E7 UPS fl . OSO!GL5❑ Hand Defively ❑ lee Ch Etak Or Nolo ❑ E3ax D VE ING ❑ <br /> Paoc L.t.b Fia]d SarYies ll Other❑(SPsC*) _— Other ❑(spe elft'). <br /> Rafrl Brant; ]re Ef Blue Ice❑ Folio-❑ OEfYBr❑ GaLrtmonds: <br /> Gustody Seals lea CIM51tt] ontalllsl�❑ Rom[} Camrn nla: <br /> ILde os Q NMQ IMr217Y0s G[f0 fl <br /> AIJ seYSplPs{oCOLw9�7 Yes No❑ 411 sempluEteo[I[wllwrs ndad? Yee Vo 13 pesrrlpUSn(s)meRch l Y d!a G <br /> pC P.BCB�V� Elms=twat': q5jl� $ rR q'-- -Z-14 <br /> AYES D No TornPoraLuro; A 11 •C (c .c Al IML <br /> SAMPLI_NuMl <br /> SAMPLE CONTAUE148r . is <br /> } E a S s 7 <br /> F[S IRJPRR <br /> 4�0erarl��r r�L1NPaiLR <br /> C: <br /> ,+,l 11MiLtALMEfALS <br /> INOR CEiESMIC hi F'_TI,LSdut Ill 4 39u- <br /> TAGCM l <br /> UTOTALSUL E <br /> �,C,LL TFINrrR�TE <br /> TOTAL I,¢lEC C11&11aY1 <br /> {_IIEDi]CA.L�kvl.RN OQIflANf1 <br /> PkA <br /> PIIEKLOUCS <br /> � h V[ALT �'-RLa4H[C <br /> New h S�LAL ' <br /> T LTA LGS9a <br /> PT U <br /> RAMDW <br /> Euc.[}E1CJL <br /> 40 A VIAE-SH — <br /> fPAS[NfCAk IA <br /> i <br /> Q'j'$.A K3J6ESJA — <br /> T LSjjL- <br /> !�3' <br /> 'EPA 32U TLS <br /> 4l ._. <br /> dlmg EPA"LI <br /> 7 EPA Il <br /> PA 3DLSK- <br /> 4�-Tgl <br /> alldoLMM AinBJiN - <br /> dL I�sl3�trt tAR <br /> 541E 5L V ' <br /> PCE VIAL <br /> Al 3 @AG — <br /> T s[L1G <br /> I v E <br /> J 1k Ch HISti 6l� <br /> ComrJICRLS= <br /> Sompre Numherrnfl cpMplebad Ay: da] Flrlla �"' ��°ataor:z <br /> AwAt[unl tL�aJarLwrnJ,.Plt�nauuca,ahvrocwaEtr,r31) <br /> The results in this report apply to the samples analyzed in accordance with the chain of custody document.This analytical report must be reproduced in its entirety. <br /> All results listed in this report are for the exclusive use of the submitting party. Pace Analytical assumes no responsibility for report alteration,separation,detachment or third party interpretation. <br /> Report ID: 1001456910 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.pacelabs.com Page 4 of 16 <br />
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