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ARCHIVED REPORTS XR0003352
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2705
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3500 - Local Oversight Program
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PR0544595
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ARCHIVED REPORTS XR0003352
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Entry Properties
Last modified
6/24/2019 11:47:45 AM
Creation date
6/24/2019 10:59:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003352
RECORD_ID
PR0544595
PE
3528
FACILITY_ID
FA0002048
FACILITY_NAME
TESORO (Shell) 68221(WRR 6290)
STREET_NUMBER
2705
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12121008
CURRENT_STATUS
02
SITE_LOCATION
2705 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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• <br /> Billing Inform�on Page 2 of 2 <br /> CHAIN-OF-CUSTODY RECORD CA <br /> Alpha Analytical, Inc. WorkOrder : STR05091426 <br /> 255 Glendale Avenue,Suite 21 Sparks,Nevada 89431-5778 <br /> TEL (775)355-1044 FAX (775)355-0406 Report Due By : 5.00 PM On • 22-Sep-05 <br /> Chert Scott Bittinger <br /> Stratus Environmental TEL (530)676-6009 x <br /> 3330 Cameron Park Drive FAX (530)676-6005 EDD Required Yes <br /> Suite 550 EMad sbrthnger@stratussnc net <br /> Cameron Park,CA 95682-8861 Sampled by Justin Crose <br /> Report Attention Scott Bittinger Job 2007-0835-011 USA Gas Station No 835 Cooler Temp 4°C Date Printed <br /> CC Report PO Client's COC# 6510 14-Sep-05 <br /> QC Level S3 = Final Rpt,MBLK LCS,MS/MSD With Surrogates <br /> Requested Tests <br /> Alpha Client Collection No Of Bottles ALCOHOL_ALCOHOL_ TPHIP_S Req W VTC 5 VOC W <br /> Sample ID Sample ID Matrix Date ORG SUB TAT PWS# s w <br /> p p Sample Remarks <br /> STRO5091426-07A CPT-4-74 SO 09/09/05 9 0 6 M.OH 1 BTXFV) � BTXiJGAs✓ <br /> 1226 EtOH Spxys![2 5axys!1,2 <br /> DCA, DCA EDB_ <br /> EDB C <br /> I <br /> Comments Security seals intact,ice frozen Ca samples Send_copy of receipt checklist with final report For sample#02 lab received 3voas broken <br /> Signature I Print]Name Company Date/time <br /> Received b ' I ' <br /> Y �' r F �/' Alpha Analytical,Inc <br /> NOTE Samples are discarded 60 days after results are reported unless other arrangements are made Hazardous samples will be returned to client or disposed of at client expense <br /> The report for the analysis of the above samples is applicable only to those samples received by the laboratory with this COC The liability of the laboratory is limited to the amount paid for the report <br /> Matrix Type AQ(Aqueous) AR(Air) SO(Soil) WS(Waste) DW(Drinking Water) OT(Other) Bottle Type L-Liter V Voa S-Soil Jar O-Orbo T-Tedlar B Brass P-Plastic OT-Other <br />
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