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ARCHIVED REPORTS XR0003365
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 XR0003365
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Entry Properties
Last modified
6/24/2019 2:29:55 PM
Creation date
6/24/2019 1:29:22 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003365
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 Custo Number q3S-1 <br /> 0 <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento 0 Additional documents are attached,and are part of this Recons <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#14117 <br /> �Rarvcho Cordova,CA Location 2725 Country Club Blvd <br /> Stockton,CA <br /> Project# 77EL14117 Task# 0410 lysis Request <br /> Project Manager JaffAuchterlonie a <br /> Laboratory Kill Analytical W <br /> Turnaround Time Standard <br /> a om <br /> Sampler's Name Damn Brown a g 9 <br /> ,A oo boa co o $ <br /> Sampler`s Signature E o a N R m m m <br /> s� s x Ego ' 4 a Comments! p <br /> Sample ll] Date Time matrix = � 0 m V w±o F w Instructions z' <br /> �. - - 7J� `1124hr q'fr water X tr 01 <br /> 11.0v wafer x X o� <br /> GPT-3-- 11 0' "� it'ss WV* x X 03 <br /> C PT-2-- 70' L41 74/0-e yr waou- x 7( 3 Ot <br /> 05" <br /> Tom--rlo' "lulus �I,�o w fi � � <br /> c Prl'-% - ZO' ros <br /> CPT-I - 9Z' ` 2.1/os vyo 'Jew X 4 <br /> C.iPT�i J I G r 4li�o s Weft x x � � <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> Sign Sign Total no of containers <br /> email results to dbrown@secor com Print Damon Brown Print Chain of custody seals <br /> dherzog@secor.com Company SECOR Company Redd in good condthon/oold <br /> Time Date a- Tim e Date Conforms to nmord <br /> Relinquished by A&mved by WX <br /> Sign Sign Client SECOR <br /> Print Print COUL Client Contact Damon Brown <br /> Company Company Kiff Ana cal Client Phone (916)861IM-M -0400 <br /> Time Date Time J'3�Date ext 230 <br /> a RN� <br /> Date `IIZ6&-r Page 1 oft <br />
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