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SR0079995
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4200/4300 - Liquid Waste/Water Well Permits
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SR0079995
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Entry Properties
Last modified
7/16/2020 1:40:05 PM
Creation date
3/27/2019 8:23:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
SR0079995
PE
2602
FACILITY_NAME
BLOCK 21 WINERY
STREET_NUMBER
21600
Direction
N
STREET_NAME
DAVIS
STREET_TYPE
RD
City
LODI
Zip
95242
APN
01308043
ENTERED_DATE
12/17/2018 12:00:00 AM
SITE_LOCATION
21600 N DAVIS RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
TMorelli
Tags
EHD - Public
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FGL Environmental Doc ID: 3DO900002_SOP_12.DOC <br /> Revision Date: 10/09/14 Page 1 of 1 <br /> Inter-Ltory Condition Upon Receipt (Attach to COC)I9,06 .3 <br /> • Sample Receipt at: STK CC CH VI <br /> 1. Number of ice the packages received: I Shipping tracking# <br /> 2. Were samples received in a chilled condition? Temps:e4�,F / / <br /> Surface water SWTR bact samples: A sample that has a temperature upon receipt of >10°C,whether iced or not, <br /> should be flagged unless the time since sample collection has been less than two hours. <br /> 3. Do the number of bottles received agree with the COC? ge <br /> No N/A <br /> 4. Were samples received intact?(i.e. no broken bottles, leaks etc.) No <br /> 5. VOAs checked for Headspace? No N/A <br /> 6. Were sample custody seals intact? Yes No <br /> 7. If required, was sample split for pH analysis? Y es No IB <br /> 8. Were all analyses within holding times at time of receipt? No <br /> 9. Verify sample date, time and sampler name Yes No <br /> Sign and date the COC, place in a ziplock and put i he- a ice chest as the samples. <br /> Sample Receipt Review completed by (initials): <br /> Sample Receipt at SP: <br /> 1. Were samples received in a chilled condition? Temps: <br /> Acceptable is above freezing to 6XI C. If many packages are received at one time check for tests/H.T.'s/rushes/ <br /> 2. Shipping tracking numbers: <br /> 92" lo"'o 0 <br /> • 3. Do the number of bottles received agree with the COC? e No N/A <br /> 4. Were samples received intact?(i.e. no broken bottles, leaks etc.) es' No <br /> 5. Were sample custody seals intact? Yes No 1/ <br /> Sign and date the COC, obtain LIMS sample numbers, select methods/tests and print labels. <br /> Sample Verification, Labeling and Distribution: <br /> 1. Were all requested analyses understood and acceptable? No <br /> 2. Did bottle labels correspond with the client's ID's? a No <br /> 3. Were all bottles requiring sample preservation properly preserved? Yes No a FGL <br /> [Exception:Oil&Grease,VOA and CrVI verirsed in labl <br /> 4. VOAs checked for Headspace? e No N/A <br /> 5. Have rush or project due dates been checked and accepted? es No N/A <br /> 6. Were all analyses within holding times at time of receipt? e No <br /> Attach labels to the containers and include a copy of the COC for lab delivery. <br /> Sample Receipt, Login and Verification completed by (initials): <br /> Discrepancy Documentation: <br /> Any items above which are "No"or do not meet specifications (i.e. temps) must be resolved. <br /> 1. Person Contacted: Phone Number: <br /> Initiated By: Date: <br /> Problem: <br /> Resolution: <br /> (3-16608) <br /> 2. Person Contacted: Ti i ra van �v l vi ronmenta l <br /> • Initiated By: <br /> Problem: STK1853663 <br /> Resolution: <br /> APB-09/19/2018-17:06:40 <br /> (Please use the back of this sheet for additional comme—__ re <br /> contacts) -- <br />
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