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ARCHIVED REPORTS XR0006976
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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E
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103
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3500 - Local Oversight Program
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PR0544638
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ARCHIVED REPORTS XR0006976
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Last modified
7/9/2019 3:36:54 PM
Creation date
7/9/2019 2:18:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006976
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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Alpha Analytical, Inc. <br /> Phone (775) 355-1044 FAX (775)355-0406 <br /> Sample Receipt Checklist <br /> Date Report is due to Client 213/2006 Date of Notice 113112006 1 00 25 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 2001-0103-1 <br /> Project Manager Scott Bittinger Client's EMail sbittinger@stratusino net <br /> Clients Phone (530)676-6009 Client's FAX (530)676-6005 <br />' Work Order Number STRO6013122 bate Received 1/31/2006 Received by Tasha Pascal <br /> Chain of Custody(COG)Information <br />' Carrier name FedEx <br /> Chain of custody present? Yes R� ❑ No <br /> Custody seals intact on shippping container/cooler? Yes S?] ❑ No Not Present ❑ <br />' Custody seals intact on sample bottles? Yes ❑ ❑ No Not Present ❑d <br /> Chain of custody signed when relinquished and received? Yes 0 ❑ 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 W1 ❑ No <br />' Internal Chain of Custody(COC)requested? Yes ❑ © No <br /> Contract Lab Used None ❑ ❑ S>wM Qther(see comments} ❑ <br /> Sample Receipt Information <br />' Shipping container/cooler in good condition? Yes 0 ❑ No Not Present ❑ <br /> Samples in proper containerlbottle? Yes ❑ ❑ No <br />' Sample containers intact? Yes No <br /> Sufficient sample volume for indicated test? Yes k/A ❑ No <br />' Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes ❑d ❑ No Cooler Temperature <br /> Container/Temp Blank temperature in compliance(0-6°C)? Yes ❑d ❑ No 4°C <br />' Water-VOA vials have zero headspace 1 no bubbles? Yes 0 ❑ No No VOA vials submitted ❑ <br /> Sample labels checked for correct preservation? Yes ❑ No <br /> TOC Water-pH acceptable upon receipt(H2SO4 pH<2)? Yes ❑ ❑ No NIA <br /> Analytical Requirement Information <br />' Are non-Standard or Modified methods requested? Yes 1:1 R] No <br /> Are there client specific Project requirements Yes ❑ ❑ No If YES seethe Cham of Custody(COC) <br />' Comments <br /> 1 <br />
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