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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0543804
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Last modified
6/28/2019 2:04:14 PM
Creation date
6/28/2019 1:20:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0543804
PE
2950
FACILITY_ID
FA0024907
FACILITY_NAME
7-ELEVEN STORE #20632
STREET_NUMBER
4627
STREET_NAME
DA VINCI
STREET_TYPE
DR
City
STOCKTON
Zip
95207
CURRENT_STATUS
01
SITE_LOCATION
4627 DA VINCI DR
P_LOCATION
01
QC Status
Approved
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EHD - Public
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Chain of Custody Number: <br /> Stantec Chain-of Custody Record ' <br /> Field Office: 077 Sacramento Q Additional documents are attached, and are part of this Record. <br /> Address: 3017 Kilgore Road,Suite 100 Job Name: 7-Eleven Store#20632 <br /> Rancho Cordova,CA Location: 4627 Da Vinci Drive <br /> Stockton, California <br /> Project# 77EL.20632.48 Task# 0410 Analysis Request <br /> Project Manager Damon Brown <br /> 0 <br /> Laboratory Kiff Analytical y 8 e <br /> Turnaround Time a r _ <br /> '2 W Q w a m 80 >' ov a <br /> Sampler's Name " e $ > 2 °' m <br /> Sampler's Signature m °€ i N a <br /> _ i< <br /> Commentsle o ENo a <br /> o. <br /> Sample 1D Date ime Matrix a > <br /> Instructions z <br /> AMPLE RECEIPT <br /> erm.ID#-.U-—I <br /> T3� <br /> e /No <br /> Special Instructions/Comments RRelinqui Received by: Sam le Recei t <br /> 6 Oxygenates: TAME, MtBE, EtBE, TSA,& DIPE Sign / Total no.of containers: <br /> Global ID#T0607700798 (SIRC) Print i Chain of custody seals: <br /> email EDD to patrick.herrmann@stantec.com y Company Recd in good condition/cold: <br /> email results to patrick.herrmann@stantec.com, Time sz!?g!►. Date t zo Time Date Conforms to record: <br /> damon.brown@stantee.com and Relinquished by: 46ceivedl by: w� <br /> patrick.schiller@stantec.com Sign Sign ti- Client: Stantec <br /> Print Print ti f u Client Contact: Damon Brown <br /> Company Company Client Phone: (916)861-0400 <br /> T50-- Date Time 01a< Date o/zpl ext.230 <br /> SECOR CU9TFiEC Rev 2100 <br /> Date: ) f Zo/oq Page <br />
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