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EnvironmentalHealth
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2900 - Site Mitigation Program
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PR0538097
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Last modified
2/1/2019 2:16:09 AM
Creation date
1/31/2019 3:51:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0538097
PE
2950
FACILITY_ID
FA0022005
FACILITY_NAME
JUANS AUTO REPAIR
STREET_NUMBER
1145
Direction
S
STREET_NAME
AURORA
STREET_TYPE
ST
City
STOCKTON
Zip
95206
APN
14733030
CURRENT_STATUS
01
SITE_LOCATION
1145 S AURORA ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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MR <br /> AC--C_—LJTr-=--T Accutest Laboratories Sample Receipt Summary <br /> IA60R AT ORIF. <br /> Accutest Job Number: C31148 Client: ENCON SOLUTIONS Project: 1145 AURORA-STOCKTON,CA <br /> Date/Time Received: 11/26/2013 Delivery Method: Accutest Courier Airbill#'s: <br /> Cooler Temps(initial/Adjusted): #1:(3.213.2); 0 <br /> Cooler Security Y or N Y or N Sample Integrity-Documentation Y or N <br /> 1.Custody Seals Present: ❑ d❑ 3.COC Present: W ❑ 1.Sample labels present on bottles: ❑ <br /> 2.Custody Seals Intact: ❑ ❑ 4.Smpl Dates/Time OK ❑d ❑ 2.Container labeling complete: ❑ <br /> Cooler Temperature Y or N 3.Sample container label/COC agree: ❑ <br /> 1.Temp criteria achieved: 0 ❑ Sample IntegritV-Condition Y or N <br /> 2.Cooler temp verification: IR2 Plastic; 111.Sample recvd within HT: ❑� <br /> 3.Cooler media: Ice(Bag) <br /> 2.All containers accounted for: ❑ <br /> 4.No.Coolers: 1 <br /> ---- ---- ---- 3.Condition of sample: Intact <br /> Quality Control Preservation Y or N N/A Sample Integrity-Instructions Y or N N/A <br /> 1.Trip Blank present/cooler: ❑ El <br /> 1.Analysis requested is clear: ❑ <br /> 2.Trip Blank listed on COC: ❑ ❑ ❑e 2.Bottles received for unspecified tests ❑ V <br /> 3.Samples preserved properly: ❑ ❑ 3.Sufficient volume recvd for analysis: ❑ <br /> 4.VOCs headspace free: ❑ ❑ ❑d 4.Compositing instructions clear: ❑ ❑ ❑J <br /> 5.Filtering instructions clear: ❑ ❑ W <br /> Comments <br /> Accutest Laboratories 2105 Lundy Avenue San Jose,CA 95131 <br /> V:408.588c200 F:408.588.0201 www/accutest.com <br /> C31148: Chain of Custody <br /> Page 3 of 3 <br /> No 48 of 80 <br /> E.4r-.rutJTF=S;T <br /> C31148 `...fl <br />
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