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ARCHIVED REPORTS XR0003353
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 XR0003353
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Entry Properties
Last modified
6/24/2019 11:46:03 AM
Creation date
6/24/2019 11:01:42 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003353
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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• AGENDED - <br /> Billing Information C N-OF-CUSTODY RECORD CA Page 2 eft <br /> - <br /> I <br /> Alpha Analytical, Inc. WorkOrder : STR05092906 <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 : 06-Oct-05 <br /> Client Gown Kowtha <br /> Stratus Environmental TEL (530)676-6001 <br /> 3330 Cameron Park Drive FAX (530)676-6005 EDD Required Yes <br /> Sude 550 EMail gkowtha@sftkmnc.net <br /> Cameron Park,CA 95682-8861 — Sampled by M Morgan/V Zalutka <br /> Report Attention Gown Kowtha Job 2007-0835-011USA 835 Cooler Temp 4°C Date Printed <br /> CC Report PO Client's COC# 6832 18-Oct-05 <br /> OC Level S3 Final Rpt,MBLK,LCS,MS/MSD With Surrogates <br /> Requested Tests <br /> Alpha Client Collection No of Bottles ALCOHot- <br /> TPnTPxrP_w voc_w <br /> w <br /> Sample ID Sample ID Matrlx Date ORG SUB TAT PWS# Sample Remarks <br /> STR05092906-11 VEW-1 AQ 09/28/05 6 1 0 1 $ 1 1 MCOHI TPHIE C GAs BTEX10XY1 <br /> 0925 F1OH t zocA c <br /> �TR05092�6 1 VEW 3 AQ 09/28/05 8 0 5 MIK)H I TPWE_C GAS C a 2DCA-rl Sample ID drffers from <br /> 0950 Doll i"Io c chain,logged in per chain <br /> I <br /> Comments Security seals intact,frozen ice Send copy of receipt checklist wuh final reporl Amended 10-18105 to change ID on sample12,_per Tammy(a)SEC via Rema SS <br /> Signature PrintName - - - T -- -- F -- <br /> ------- - ---- - - - ------- - - —L ----- --�--------- Company- <br /> Logged in by - � _ - - - --- - -S_- 51 _ i - -- - - — - 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) Battle Type L-Liter V-Voa S-Soil Jar O Orbo T Tedlar &Brass P-Plastic OT-Other <br />
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