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ARCHIVED REPORTS XR0003429
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 XR0003429
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Entry Properties
Last modified
6/24/2019 11:50:42 AM
Creation date
6/24/2019 11:05:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003429
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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HOUSTON LABORATORY <br /> 8880 INTERCHANGE DRIVE <br /> HOUSTON,TEXAS 77054 <br /> ® {713)660-0941 <br /> Sample Receipt Checklist <br />' Workorder 00080243 Received by Stelly,D'Anna <br /> Date and Time Received 819100 10 00 00 AM Camer name FedEx <br />' Temperature 4 <br /> i <br /> Shipping container/cooler in good condition? Yes &Z No❑ Not Present ❑ <br />' Custody seals intact on shippping containerlcooier? Yes No ❑ Not Present <br /> Custody seals intact on sample bottles? Yes ❑ No ❑ Not Present <br />' Chain of custody present? Yes No ❑ <br /> Chain of custody signed when relinquished and received? Yes No LJ <br /> Chain of custody agrees with sample labels? Yes W No ❑ <br />' Samples in proper containerlbottle? Yes fir No <br /> Sample containers intact? Yes I No j <br />' Sufficient sample volume for indicated test? Yes U No <br /> Ail samples received within holding time? Yes k No <br /> bontaineriTemp Blank temperature in compliance? Yes U No <br /> Water-VOA vials have zero headspace? Yes J No — Not Present <br />' Water-pH acceptable upon receipt? Yes �l — No —' — <br /> 1 <br /> 1 <br /> 1 <br />
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