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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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Cham of Custody Number 1 :2- <br /> SECOR <br /> SECOR Chain-of Custody Record <br /> Feld Office 077 Sacramento [3 Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#14117 <br /> Rancho Cordova,CA Location 2725 Country Club Blvd <br /> Stockton,CA <br /> Project# 77EL14117. Task# 0410 Anal is Request <br /> Prosed Manager Jaff Auchtertonte a <br /> Laboratory Kiff AnaWical y <br /> Turnaround Time Standard W <br /> ° 0� �m <br /> Sampler's Name Damon Brown g „ e,o m o 0 91 <br /> Sampler's Signature o e 2 "� � $ ` � <br /> C a$ a m I W m Q 4 N d Comments) JE <br /> Sample ID Date Time Matrix i 3l ti > z �w W — �' Instructions <br /> CPT-i - &0" u z 10,30 Soil X X ~ ' <br /> CST- ti - Z0' -.1105 tt'&f0 5W, ?C X -07 <br /> CPT -i - 8v' "(_ /Zito s0;� X X X CPT- - 1oS' '��Lvf a� 3• So:1 X XGP-1 - ro' y�1. tUSalk -�� <br /> Special Instruchons/Comments Relinquished by Received by Sample Receipt <br /> Sign Sign Total no of containers <br /> email results to. dbrown@secor.com Print Damon Errown Print Chain of custody seals <br /> dherzog@secor corn Company SECOR Company Recd in good condition/cold <br /> Time Date 4 z a Tim Date Conforms to record <br /> Relinquished by eceved b <br /> Sign Sign Client SECOR <br /> Print Print Client Contact. Damon Brown <br /> Company Company Kiff Anal cal Client Phone 916 861-0400 <br /> Time Date Time 31 Date 2op-4ext 230 <br /> BE=CUSrRM RW <br /> '�' Date Page of <br />
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