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ARCHIVED REPORTS XR0003320
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 XR0003320
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Entry Properties
Last modified
6/28/2019 3:57:22 PM
Creation date
6/28/2019 2:06:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003320
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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Cham Qf Custody Number <br /> SECOR Chain-of Custody kecord- - y <br /> Field Office 077 Sacramento El Additional documents are attached, re part of this Record <br /> Address 3017 Kilgore Road, Suite 100 .fob Name 7-Eleven Store#20632 <br /> Rancho Cordova, CA Location 4627 Da Vinci Drive <br /> Stockton, California TZ, <br /> Project# 77EL 20632 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Kiff Analytical _ a <br /> com h <br /> 00 <br /> Turnaround Time Standard <br /> d r w cII N = <br /> Samplers Name � ,QT�¢,�Il x ' °LU <br /> y <br /> v <br /> d = <br /> aaR R (] <br /> Samplers Signature E U o N a=s o � cv <br /> Comments/ <br /> Sample ID Date Trme Matrix = W a W _ to co L co <br /> � � ° w. Instructions z <br /> ✓ MW-1 Water X X <br /> MW-2 r3r6 Water X X <br /> MWS le'�5� Water X X <br /> MW-4R l3' S Water X X <br /> MW-5 Water X X <br /> MW-6 1135 Water X X y <br /> J MW-7 Water X X <br /> Special Instructions/Comments Relinqu hed b '10 >Print <br /> Sam le Recei t <br /> 5 Oxygenates, TAME, MtBE, EtBE,TBA, & DIPE Sign Total no of containers <br /> Global ID#T0607700798(SIRC) Print B KSS Chain of custody seals <br /> EDF Deliverables Compa y Recd in good condition/cold <br /> email results to bcarey@secor,com Time Date ]Date Conforms to record <br /> Relinqui hed by Received by <br /> Sign Sign ��...�,...� Client SECOR <br /> Print Print ;6!f'0:2 4 ar"5CA-V Client Contact Brian Carey <br /> Co y Company & ( �4e Client Phone (916)861-0430 <br /> Time _Date Time f p. Date 032323 ext. 241 <br /> RECOR CUSUWC.Rev zw <br /> Date 3-,Z6-413 Page <br />
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