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ARCHIVED REPORTS XR0003319
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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D
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DA VINCI
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4627
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2900 - Site Mitigation Program
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PR0543804
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ARCHIVED REPORTS XR0003319
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Entry Properties
Last modified
6/28/2019 3:55:04 PM
Creation date
6/28/2019 2:06:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003319
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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Tags
EHD - Public
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• Chain of Custody Number s---Z S jb • <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 100 Job Name 7-Eleven Store#20632 <br /> Rancho Cordova,CA Location 4627 Da Vinci Drive <br /> Stockton, California <br /> Project# 77EL.20632 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonle <br /> Laboratory Kiff Analytical <br /> Turnaround Time <br /> Standard <br /> W � R o <br /> Samplers Name <br /> Samplers Signature g <br /> Comments/ <br /> Sample ID Date TimeMatrix g y g ° Instructions z <br /> Mw-1 ?o , Yo Water X X 0[ <br /> MW-2 eta 1530 Water X XV 62 <br /> MW-3 Jas Water X X V 16� <br /> MW4R 03 /V30 Water X X <br /> MW-5 3 Water X X <br /> MW-6 S 0.1 /'So Water X X o1a <br /> MW-7 IVIT Water X X <br /> Q� <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> 5 Oxygenates•TAME, MtBE, EtBE,TBA,& DIRE Sign Sign Total no of containers <br /> Global ID#70607700798(SIRC) Print ' Pant Chain of custody seals <br /> EDF Deliverables Company Compa Recd in good conditEon/cold <br /> entail results to bearey@secor.com Time Date Tim Date Conforms to record <br /> Relinquished by Receive <br /> Sign Sign Client SECOR <br /> Print Print 1� Client Contact Brian can <br /> Compan Company 1G �nc.� Client Phone (916)861-0430 <br /> TI Date Time l S o L, Date n 21 o ext.241 <br /> SECOR CUSTREC Rev M <br /> Date Page <br />
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