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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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BENJAMIN HOLT
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3040
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2900 - Site Mitigation Program
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PR0529219
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Last modified
2/6/2019 3:57:58 PM
Creation date
2/6/2019 3:50:04 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0529219
PE
2950
FACILITY_ID
FA0019477
FACILITY_NAME
7-ELEVEN INC #14113
STREET_NUMBER
3040
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95219
APN
10027018
CURRENT_STATUS
01
SITE_LOCATION
3040 W BENJAMIN HOLT DR
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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Chain of Custody Number: 710 n L <br /> Stantec Chain-of Custody Record <br /> Field Office: 077 Sacramento ® Additional documents are attached, and are part of this Record. <br /> Address: 3017 Kilgore Road Suite 100 Job Name: 7-Eleven Store#14113 <br /> Rancho Cordova, CA Location: 3040 W Benjamin Holt Drive <br /> Stockton, CA <br /> Project# 77EL.14113.28 Task# 0403 Analysis Request <br /> Project Manager Damon Brown a <br /> Laboratory Kiff Analytical w m N ; 8 0 <br /> w a < c m 5 <br /> Turnaround Time Standard m x 8CR <br /> jm o O <br /> Sampler's Name o o On Wvm <br /> ens/Sampler's Signature Comments/ <br /> U_ <br /> E <br /> Sample ID Date Time Matrix i m a` > Instructions <br /> SP1(ABCD) q 1 :00 Soil X X Please Composite 4 into 1 4 a i <br /> am °C K.a Therm.10# S <br /> Initial, _Data D2� <br /> Tlni Coolant present; No <br /> id1309H 31dYltl <br /> Relin uis d Received by. Sample Recei t ` <br /> Special InstructionsfComments q Y' / Total no.of containers. <br /> Combine soil samples Si SP1-B, SP1-C, and SP1- Sign Sign Chain of custody seals: <br /> D into one composite sample SP1(ABCD) Print olio Rya Print <br /> Company Stantec Company Recd in good condition/cold: <br /> email lab report to damon.brown@stantec.com, p y Date Time / Date- <br /> patrick.herrmann@stantec.com <br /> to record: <br /> patrick.herrmann@stantee.com and Time y+W <br /> patrick.schlller@stantec.com Relinquished by: ecelved by. <br /> Sign Sign Client: Statnec <br /> Print Print y 2T' Client Contact Damon Brown <br /> Company Company( Client Phone: l916)861-0400 <br /> Ti Date Time /Olio Date ozo�o� ext. 230 <br /> s=_cou cosivec er.va° Date: 711101 Page '�' <br />
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