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ARCHIVED REPORTS XR0003356
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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2725
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3500 - Local Oversight Program
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PR0544596
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ARCHIVED REPORTS XR0003356
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Entry Properties
Last modified
6/24/2019 2:26:39 PM
Creation date
6/24/2019 1:23:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003356
RECORD_ID
PR0544596
PE
3528
FACILITY_ID
FA0002064
FACILITY_NAME
7-ELEVEN INC. STORE #14117
STREET_NUMBER
2725
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
02
SITE_LOCATION
2725 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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Chain of Custody Number •j�� <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento D Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgore Road,Sults 100 Job Name 7-Eleven Store#14117 <br /> Rancho Cordova,CA Location 2726 Country Club Blvd. <br /> Stocktion,California <br /> Propct# 77EL14117 04 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchtedonle <br /> Laboratory Kill Ana cal 8 4 <br /> Turnaround Time Standarda � <br /> c2 > <br /> Sampler's Name Tom Miller o > r, <br /> Sampler's Signature a R `" Comments) e <br /> x = x E a S. 9 in a <br /> Sample ID Date Time Maft z dem �m x o CO m ID w Instructions <br /> MW-1 6. / H2O x X I I I X — } 3 <br /> MW-2 G-? f.Yi H2O x X X `v2 3 <br /> MW-3 6-9--y 1736 H2O x X X I 1 3 <br /> MW-4 6- 'C400 H2O x X I X1 1 3 <br /> MW-5 6-9 - H2O x X X —0 3 <br /> MW-6 9-9---f pa H2O x X X 3 <br /> MW-8 6 16 y H:o x X X c 3 <br /> Special Instructions/Com ments Relinquished by ar Received by Sample Receipt <br /> 5 Oxygenates:TAME,MtBE,EtBE,TBA,&DIPE Sign Sign Total no of containers <br /> Global ID#T0607700 B(SiRC) Pnnt Pnnt Cham of custody seals <br /> email EDD dacatlin@secor com Company C ��_ Compan Recd in good condrtion/cold <br /> small lab report to dherzog@secor com and Time Date Ti Date Conforms to record <br /> bcarsy&ecor cam Relinquished by Received <br /> Sign Sign Client. SECOR <br /> Pnnt Pnnt oeqa.l Client Contact. Brian Ca <br /> Campan Company a. Client Phone (816)861-0400 <br /> Ti Date Time I�F50 Date DLUO.,� ext.241 <br /> SECMC ffrRWn«ZU <br /> Date Page /+e--/ <br />
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