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ARCHIVED REPORTS XR0003358
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 XR0003358
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Entry Properties
Last modified
6/24/2019 5:26:55 PM
Creation date
6/24/2019 1:23:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003358
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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SJGOV\wng
Tags
EHD - Public
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0 <br /> Chain of Custody Number 3U0 <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento ®Additional documents are attached and are part of this Record <br /> Address 3017 Kilgore Road,Suite 900 Job Name 7-Eleven Store#14917 <br /> Rancho Cordova,CA Location 2725 Country Club Blvd <br /> Stockton,California <br /> Protect V, 77EL14117 44 Task# 0410 Analysis Request <br /> Project Manager .gaff Auchterlonie <br /> I Laboratory Kfft Analytical _ _ E e v <br /> i Turnaround Time Standard Z & m E 2 <br /> R �+ m E o m L o <br /> E FC z v j ¢ <br /> Sampler's Name Tom biller s^ + ¢ o _o 6 <br /> m ?) m w <br /> Samplefs Signatiar m �, �, a E o m x 0 w Comments/ <br /> o <br /> Scmnie (t] Date Time Matnx 0 w a i z m©t $ 2 x U z t or Instructions z' <br /> €" -1 0 / oa H2O x 1 <br /> 0 /yob H10 x <br /> rtdiW-# g /b .q /qco H2O x 1 <br /> rW-1 (goo H2O x 1 <br /> Nlklf-1 /G o J�Up H2O x 1 <br /> H2O x 48-hr hold Ume 1 a` <br /> MW-9 /t oy / oa H2O x 1 <br /> i MM H2O x 48-hr hold time 1 <br /> /19,40 H70 x 24-hr hold time i <br /> W-1 8 / ba H2O x <br /> iM1 <br /> liW-1 rfil fief l ivoo H2O x 1 <br /> MW-1 o /y bb H2O I x <br /> Special Iris4uctlonslCornments Relinquished b a Received by Sample Rempt <br /> All samples littered in the field.Calculate ion balance Sign Sign Total no of containers <br /> Pnnt a,.� ,fl=,_ - - Pnnt Cham of custody seats <br /> Company ,ti Compa Redd in good condition/cold <br /> Time Date Time Date Conforms to mord <br /> Relinquished by Received by <br /> Sign Sign Af Client: SECOR <br /> Pnnt Pnnt o Client Contact Daniel Davis <br /> Compa Company Client Phone (916)8614WO <br /> Time Date Time /j -Date o 9 6 ext 226- <br /> SEMI CUSS EG Net ZW <br />
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