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ARCHIVED REPORTS XR0003352
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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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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Billing'"f CHAIN-OF-CUSTODY RECORD Page 1 of <br /> CA <br /> Alpha Analytical, Inc. WorkOrder : STRO5091429 <br /> 255 Glendale Avenue,Suite 21 Sparks,Nevada$9431-577$ <br /> ' TEL (775)355-1044 FAX (775)355-0406 Report Due By • 5:00 PM On : 22-Sep-05 <br /> Client Gown Kowtha <br /> Stratus Environmental TEL (530)676-6001 x <br /> 3330 Cameron Park Drive FAX (530)676-6005 EDD Required Yes <br /> Suite 550 EMail gkowtha@stratusmc net <br /> Sampled by Scott B <br /> Cameron Park,CA 95682-8861 <br /> Report Attention Gown Kowtha Job 2007-835-11 Palisades Station 835 Cooler Temp 40C Dale Pnnted <br /> CC Report PO Client's COC# 10998,10997 14-Sep-05 <br /> QC Level S3 = Final Rpt,MBLK,LCS MS/MSD With Surrogates <br /> i <br /> Requested Tests <br /> Alpha Client Collection No of Bottles ALCOHOL_ALCOHOL_ TPHIP_S TPHIP_w vOC s voc_w <br /> s w Sample Remarks <br /> Sample ID Sample ID Matrix Date ORG SUB TAT PWS# <br /> STR05091429-01A CPT7-11 SO 1 09/12/05 1 0 6 McOH/ BTxFJGASI BTxF1GA5r <br /> 07 58 <br /> EtOH soDC ii Z �Ens <br /> EDB C <br /> STR05091429-02A CPT7-19W AQ 09/12/05 7 0 6 McOHI sTXEKiAsr BTxFJGAsr <br /> 08 07 E,oH sox w�x HDCV z <br /> EDB C EDB_C <br /> STR05091429-03A CPT7-24 SO 09/12/05 1 0 6 Mc4H! BTxF1GA5! BTxFJGAS! <br /> 08 20 EtOH So X11 EDB <br /> EDB_C <br /> STR0509142T(14A CPT7-30W AQ 09112/05 7 0 6 i EtOH r BrxErGAS/ sTxEJGASr <br /> 0834 E,oH sox JV x s�DCu z <br /> EDB_C EDB-C <br /> STR05091429-05A CPT7-38 SO 09/12/05 1 0 6 McOH! BTXFJGASI Brx�GAsr <br /> OB 49 EtaH sou z DCN EDa <br /> EDH_C <br /> STR05091429-06A CPT7-47W AQ 09/12!05 7 0 6 EloMCOBrxysl 12 BTxys)12 <br /> 0900 EioH soDC�Z soDCAt z <br /> libB C EDB_C <br /> Comments Security seals intact ice frozen Ca samples Send copy of receipt checklist with final reort <br /> Signature Print Name Company DateMme <br /> Received by 1 Alpha Analytical,Inc / Q� <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 AO(Aqueous) AR(Air) SO(Soil) WS(Waste) DW(Drinking Water) OT(Other) Bottle Type L-Liter V-Voa S-Soil Jar 0-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br />
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