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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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i • <br /> Billing Irrfn Page 2 of 3 <br /> CHAIN-OF-CUSTODY RECORD CA <br /> Alpha Analytical, Inc. WorkOrder : STR05091429 <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 /> 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@stratusinc net <br /> Cameron Park,CA 95682-8861 Sampled by Scott B <br /> Report Attention Gown Kowtha .fob 2007-835-11 Palisades Station 835 Cooler Temp 40C Date Printed <br /> CC Report PO Client's COC# 1099810997 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_ TPWP_s TPWP W 7 s vac w <br /> s <br /> Sample ID Sample ID Matrix Date ORG SUB TAT PWS# w Sample Remarks <br /> STROS091429 D7A CPT7-57W I AQ 1 09/12/05 7 0 6 Mcoli BTXFrGAsr I I BTXEJGAsr <br /> 0925 FaoH 5oxyx/12 50xyx/12 <br /> DCA/ DCAI <br /> EDB_C EDB_C <br /> STR05091429-08A CPT7-71 SO 1 09/12/05 1 0 6 McOHI BTXVCASBT7(FJGASI <br /> 0955 EtOH Soxyd 1,211 Soxysl t 2 <br /> DCAI DC1 EDB_ <br /> EDB_C <br /> STROW91429-09A CPT7-83W I AQ 1 09/12/05 7 0 6 WOH I BTXVGASI BTXOGAsr <br /> 1010 EtOH Soxys/12 Soxys!i 2 <br /> OCIJ DCAI <br /> EDB c EDs c <br /> STRO5091429-10A CPT6-10 SO 09112105 1 0 6 MAH! BTXEJGASl MEIGAsr <br /> 1120 EtOH SoxyV 1,2 Soxydt,2 <br /> DCA! DCAIEDB_ <br /> EDB-C <br /> STR05091429-11A CPT6-94 SO 09112/0 1 0 B McOH! BTXVGAsI BrxF�GAsr <br /> 11 24 EtOrt Soxya/i z s0xysri 2 <br /> DCA/ DCAIEDB_ <br /> ED8_C <br /> STR05091429-12A CPT6-23W AQ 09/12/05 4 0 6 MAH! BTXVGAsr BTXElGAsr <br /> 1132 EtOH 5oxysl r z s0xys!t z <br /> DCAI DCAI <br /> EDB C EDB-C <br /> Comments Security seals intact ice frozen Ca samples Send co of receipt checklist with final ori <br /> Signature IPrint Name Company Datefrime <br /> Received by � drf e-4-r— � Alpha Analytical,Inc 5; <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) Battle Type L-Liter V-Voa S-Soil Jar 0-Orbo T-Tedlar B Brass P Plastic OT-Other <br />
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