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ARCHIVED REPORTS XR0000403
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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B
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BENJAMIN HOLT
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2905
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3500 - Local Oversight Program
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PR0544110
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ARCHIVED REPORTS XR0000403
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Entry Properties
Last modified
2/7/2019 10:08:16 AM
Creation date
2/7/2019 9:07:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000403
RECORD_ID
PR0544110
PE
3528
FACILITY_ID
FA0003712
FACILITY_NAME
CHEVRON STATION #94275*
STREET_NUMBER
2905
Direction
W
STREET_NAME
BENJAMIN HOLT
STREET_TYPE
DR
City
STOCKTON
Zip
95207
APN
09760004
CURRENT_STATUS
02
SITE_LOCATION
2905 W BENJAMIN HOLT DR
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
Scanner
WNg
Tags
EHD - Public
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SEQUOIA ANALYTICAL SAMPLE RECENT LOG am <br /> DATE REC'I)AT LAB• gh�1�`4 For Regulatory Purposes? <br /> CLIENT NAME: 1�''�3� DRIKKINGWATER YES/0 <br /> REC. BY(PRINT) P TIME RECD AT LAB: io1°� <br /> WORKORDER: <br /> DATE LOGGED IN: � WASTE WATER �!NO <br /> (For feats requiriny preservation checks at receipt;document Stere } <br /> LAE; DASH CONTAINER PRESMV H SAMPLE BATE REMARM: <br /> C1RC1>= 'HE APPROPRIATE RF_.SPONS>r CLIENT ID DESCRIPVON ATIVE P JVIATRIX SAMPLED CONDITION PC) <br /> 8 MPLE# # I ._[ <br /> tAJ 90/oft <br /> Vit <br /> 1. Custody Seal(s) Present! 3 r, <br /> Intact!Bra en* <br /> _s < <br /> 2 Cham-of-Gusto bsent* <br /> 3.Traffic Reports or <br /> Paclqno List Present I <br /> 4 Airbilf - Airbilf I Sticker -- <br /> Present b <br /> 5.Airbill rin <br /> 6.Sample Labeis: re IAbssnt - It <br /> 7. Sample IDs Li Not Listed �2 <br /> on Chain-of-custody Piz 711 <br /> S. Sample Condition- nta /Brokeel I <br /> Leaking* <br /> s. Does information on chain-of-custody. QCT <br /> traffic reports and sample fah Oq <br /> a reel? e o <br /> 10. Sample received wrtttin <br /> hold time? No* <br /> 11.Adequate sample volume <br /> received? a Noy' <br /> 12. Proper Preservatives <br /> u 214o* <br /> 1 ,Tnp BI amp Blank Deceived? <br /> (cinch%wh,if es e <br /> 14 Temp Rec at Lab- <br /> Is temp 4 4-2C? (fay/NO" <br /> (A=aptwrA range for samples requiring thermal Pros) <br /> **Exception(d any) METALS I DFF ON ICE <br /> or Problem COG <br /> *IF CIRCLET),CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION: <br /> $RL Revision 6 Page of <br /> �ces NavS <br /> a n7/1,�X14 <br />
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