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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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i ! � <br /> Chain of Custody Number ���" <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento Q Additional documents are attached,and are part of this Record <br /> Address 301T Kilgore Road,Suite 100 Job Name 7-Eleven Store 014117 <br /> Rancho Cordova,CA Location 2725 Courtty Club Blvd _ <br /> Stockton,CA <br /> i <br /> Project# 77EL14117. Task# 0410 Ana! is Request <br /> Project Manager Jaff Auchterlonie a <br /> Laboratory Kill Anna ical w m s3 e <br /> Turnaround Time StandardIL <br /> Samplers Name Damon Brown u o m a <br /> ao ca 2a <br /> Sampler08do <br /> Sampler's Signature—zg=m o ,o _ n d <br /> N Q Q COmmentsl $ <br /> Sample IA Date Time Matrix i m F d m 0' i 9 a °w �w Instructions Z <br /> &V P-- b41=r o W-oo water I x X `d �4 <br /> Special Instructions/Comments Relinquished by Received by Sam a Receipt <br /> Sign Sign Total no of containers <br /> email results to, dbrown@secor com Print Darvon Brown Print Chain of custody seals <br /> dherzog@secor com Company SECOR Company Recd in good conddionfoold <br /> Time Date 9 z a Tim Data Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client SECOR <br /> Print Print c PimaL Client Contact Damon Brown <br /> Company Company KIff Analytical Client Phoria 916 861-0400 <br /> Time Date Time Date cr ext 230 <br /> CUSTWC RW an <br /> Date –44"K Page %ofIb _ <br /> I <br /> I <br />
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