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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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1-0-2719 Analytical <br /> } ENVIRONMENTAL SCIENCES <br /> Chain of Custody and Cooler Receipt Form for 2318016 Page 2 of 2 <br /> FACM ANALY`fICAr. CpD(rERREGEIPTFORM Pae —Of <br /> Sub.I Won#' 11— I T{} �11� <br /> SF[jpp]NG INFORMATION $F#IpPIHIG CO[dTAkNEFt FR �SE O � <br /> FIGIS Ex 13 UPS Cl G30 f oE-s o Hand Deit-rl ❑ [e�CITCSI }Ione d &ex l3 <br /> pa;tB Lab Fleld 3erVlre d 4tnnr❑(Specl(Y) Other ❑ <br /> Rlfrl erdtl#' 4" E dLre Ice l7 HVL14�O (Mq)r Q COR1meRla: <br /> C[JetIl Seats lee Che!k(D Containers❑ None cmnmeaw. <br /> lAloot?Well No;13 n[actr'Yce No 17 <br /> All samples rcealwKL? Yea Nnd pilettnpins co[1199n6F5 Elnad3 ]fe8 No O <br /> pmcapLlanls}msfch ll Yo rxo <br /> COC RerMved LSmisei4ily ,�,4� Contra2hw� — 1rLnrrnorrely opic[7kFly Q F <br /> E{i(F.S [7 NO Taatp9 lure: (a Lf iC J E } °C AL'ial l ka <br /> SAMPLENDMI31I <br /> &WPL.IfCONTWrP.S i # 3 <br /> 7 evxFREs _ <br /> 441J 2.0 I.Il M113AMLTa <br /> OT G4CMGAN <br /> kCA 'K AI.III o .18m?Lr <br /> CYArJ11J <br /> LTROCE+�'J ICOR <br /> p'[' ;LLSI11.611JE <br /> JIM TEtr2LTrr1TE <br /> TA i. [TLC Till <br /> PT A "Ill O MAND <br /> PLAL P1 Mau <br /> ,l A VIAL. VCL HANK <br /> 41-d !.VIAL <br /> 7 UvA JQLin <br /> r;AW01-nCICAL- <br /> CTER [ACPCA <br /> d0 VJIk YJ 36{ , <br /> T EPA i 11L16L <br /> T zrA J Ia,116JSL4 <br /> {YS} <br /> E&A TrQkvb TLLAPI <br /> J IEP <br /> 40 PAS — — <br /> NL urA 54I£T <br /> .l 5#97 I <br /> TEP ir.] <br /> Hue 3� <br /> �usr 7inr J Stas JA I <br /> SOILELSIVE <br /> p VIAL <br /> F].557'1C G <br /> R i <br /> FLiR IJR� . <br /> ;?M1Y'QILIS <br /> SMART l,ur <br /> SUh]WA L`Ar71 TER <br /> GoenmelsisoaicJYlrn 4 SUM J�adlN2Y <br /> Sarnpm <br /> le Nugt rI101 Completed BT, I,�r., m,w onnrumwaL�Luc�.a�l <br /> A=AciuR1 J a=CDrr&eLed <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: 1001457976 4100 Atlas Court Bakersfield,CA 93308 (661)327-4911 FAX(661)327-1918 www.pacelabs.com Page 4 of 12 <br />
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