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ARCHIVED REPORTS XR0006975
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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103
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3500 - Local Oversight Program
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PR0544638
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ARCHIVED REPORTS XR0006975
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Last modified
7/9/2019 3:24:16 PM
Creation date
7/9/2019 2:18:10 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006975
RECORD_ID
PR0544638
PE
3528
FACILITY_ID
FA0004027
FACILITY_NAME
HENDRIX FORK LIFT INC
STREET_NUMBER
103
Direction
N
STREET_NAME
E
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15318001
CURRENT_STATUS
02
SITE_LOCATION
103 N E ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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L <br /> Alpha Analytical, Inc. <br /> Phone (775)355-3044 FAX (775)355-0406 <br /> Sample Receipt Checklist <br /> Date Report is due to Client 3/27/2006 Date of Notice 3/20/2006 1 48 06 P <br /> Please take note of any NO check marks If we receive no response concerning these items within 24 hours of the date of this notice,all of <br /> the samples will be analyzed as requested <br /> Client Name Stratus Environmental Project ID Telchert/Stoekton <br /> Project Manager Steve Carter Client's EMail scarter@stratusinc net <br /> Client's Phone (530)676-6008 Client's FAX (530) 676-6005 <br /> Work Order Number STRO6032004 Date Received 3/16/2006 Received by Stephanie Sifuentes <br /> Chain of Custody CCOC1 Information <br /> Carrier name FedEx <br /> Chain of custody present? Yes ❑ ❑ No <br /> Custody seals intact on shippping container/cooler o Yes © ❑ No Not Present ❑ <br /> Custody seals intact on sample bottles? Yes ❑ ❑ No Not Present �/❑ <br /> Chain of custody signed when relinquished and received ? Yes No <br /> Chain of custody agrees with sample labels? Yes © ❑ No <br /> Sample ID noted by Client on COC? Yes ❑ ❑ No <br /> Date and time of collection noted by Client on COC Yes © ❑ No <br /> Samplers's name noted on COC? Yes ❑ No <br /> 0rnal Chain of Custody(COC)requested? Yes ❑ � No <br /> uub Contract Lab Used None © ❑ SEM Other(see comments) ❑ <br /> Sample Receipt Information <br /> Shipping container/cooler in good condition? Yes © ❑ No Not Present ❑ <br /> Samples in proper container/bottle? Yes ❑ ❑ No <br /> Sample containers intact? Yes © ❑ No <br /> Sufficient sample volume for indicated test? Yes © ❑ No <br /> Sample Preservation and Hold Time H Information <br /> All samples received within holding time? Yes © ❑ No <br /> Cooler Temperature <br /> Container/Temp Blank temperature in compliance(0-6°C)? Yes © ❑ No 4'C <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ No No VOA vials submitted ❑ <br /> Sample labels checked for correct preservation? Yes ❑ No <br /> TOC Water-pH acceptable upon receipt(H2SO4 pHa2)? Yes ❑ ❑ No N/A 66 <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested? Yes ❑ No <br /> Are there client specific Project requirements 9 Yes ❑ No If YES see the Cham of Custody(COC) <br /> Comments Saturday delivery samples kept in secured area @4°c until log in <br />
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