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2900 - Site Mitigation Program
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PR0522056
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Last modified
5/17/2019 3:24:27 PM
Creation date
5/17/2019 2:48:06 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0522056
PE
2950
FACILITY_ID
FA0015023
FACILITY_NAME
USA GASOLINE #3502
STREET_NUMBER
35
Direction
N
STREET_NAME
CHEROKEE
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04318003
CURRENT_STATUS
01
SITE_LOCATION
35 N CHEROKEE LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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Alpha Analytical, Inc. <br /> Phone: (775)355-1044 FAX:(775)355-0406 <br /> Sample Receipt Checklist <br /> Date Report is due to Client: 10/31/2006 Date of Notice: 10/23/2006 12:41:07 <br /> Please take note of any NO check marks. If we receive no response concerning these items within 24 hours of the date of this notice,all of <br /> the samples will be analyzed as requested. <br /> Client Name: Stratus Environmental Project ID: 2007-3502-1/USA Station No.3502 <br /> Project Manager: Scott Bittinger Client's EMail: sbittinger@stratusinc.net <br /> Client's Phone: (530)676-2062 Client's FAX: (530)676-6005 <br /> Work Order Number: STR06102326 Date Received: 10/21/2006 Received by:Tasha Pascal <br /> Chain of Custody(COC)Information <br /> Carrier name: FedEx <br /> Chain of custody present? Yes V ❑ No <br /> Custody seals intact on shippping container/cooler? Yes V ❑ No Not Present ❑ <br /> Custody seals intact on sample bottles? Yes ❑ ❑ No Not Present W <br /> Chain of custody signed when relinquished and received? Yes ❑ ❑ No <br /> Chain of custody agrees with sample labels? Yes 0 ❑ No <br /> Sample ID noted by Client on COC? Yes ❑ No <br /> Date and time of collection noted by Client on COC? Yes V ❑ No <br /> Samplers's name noted on COC? Yes ❑ No <br /> Internal Chain of Custody(COC)requested? Yes No <br /> Sub Contract Lab Used : None ❑ ❑ SEM Other(see comments) ❑ <br /> Sample Receipt Information <br /> Shipping container/cooler in good condition? Yes W ❑ No Not Present ❑ <br /> Samples in proper container/bottle? Yes ❑ No <br /> Sample containers intact? Yes ❑ No <br /> Sufficient sample volume for indicated test? Yes ❑ ❑ No <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes W ❑ No <br /> Cooler Temperature <br /> Container/Temp Blank temperature in compliance(0-6°C)? Yes 0 ❑ No 4°C <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ ❑ No No VOA vials submitted <br /> Sample labels checked for correct preservation? Yes ❑ ❑ No <br /> TOC Water-pH acceptable upon receipt(H2SO4 pH<2)? Yes ❑ ❑ No N/A R] <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested? Yes ❑ 0 No <br /> Are there client specific Project requirements? Yes ❑ 0 No If YES :see the Chain of Custody(COC) <br /> Comments <br />
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