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ARCHIVED REPORTS XR0006982
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 XR0006982
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Entry Properties
Last modified
7/9/2019 3:26:30 PM
Creation date
7/9/2019 2:21:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006982
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
Scanner
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 9/1612004 Date of Notice 91812004 9 52 58 A <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 Teichert <br /> Project Manager Steve Carter Clients Phone (530) 676-6008 Client's FAX (530) 676-6005 <br /> Work Order Number STR04090822 Date Received 9/812004 Received by Gracoela Navarrete <br /> Chain of Custody COC Information <br /> Canner name FedEx <br /> Chain of custody present? Yes ❑ No <br /> Custody seals intact on shippping container/cooler 7 Yes 0 ❑ No Not Present ❑ <br /> Custody seals intact on sample bottles? Yes ❑ ❑ No Not Present RI <br /> Cham 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 0 U No <br /> Date and time of collection noted by Client on GOC? Yes ❑ ❑ No <br /> Samplers's name noted on COC? Yes ❑ No <br /> Intemal Chain of Custody(COC)requested? Yes ❑ 9 No <br /> Sub Contract Lab Used None ❑d ❑ SIM 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 F/I ❑ No <br /> Sufficient sample volume for indicated test? Yes W ❑ No <br /> Sample Preservation and Hold Time H Information <br /> All samples received within holding time? Yes ❑ No Cooler Temperature <br /> Containerfremp Blank temperature in compliance(0-6°C)? Yes ❑ No 41C <br /> Water-VOA vials have zero headspace 1 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 pH<2)? Yes ❑ ❑ No NIA 0 <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested? Yes ❑ No <br /> Are there client specific Project requirements? Yes ❑ No if YES see the Chain of Custody(COC) <br /> Comments <br />
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