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ARCHIVED REPORTS XR0006985
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 XR0006985
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Last modified
7/9/2019 3:22:11 PM
Creation date
7/9/2019 2:22:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006985
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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O <br /> Alpha Analytical, Inc. <br /> Phone (775)355-1044 FAX (775)355-0406 <br /> Sample Receipt Checklist <br /> Date Report is due to Client 1212612003 Date of Notice 12/17/2003 10 57 31 <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 /> i <br /> i <br /> Client Name Stratus Environmental Project 10 2001-01031Tetchert <br /> Project Manager Jay Johnson Client's Phone (530)676-6000 Client's FAX (530)676-6005 <br /> Work Order Number STR03121742 Date Received 12/17/2003 Received by Dolly S Baker <br /> Cham of Custody(COC)Information <br /> Carrier name FedEx <br /> Chain of custody present Yes Ll-/i ❑ No <br /> Custody seals intact on shippping container/cooler? Yes u No Not Presen ❑ <br /> Custody seals intact on sample bottles? Yes ❑ ❑ No Not Presen <br /> Chain of custody signed when relinquished and received? Yes ❑ No <br /> Chain of custody agrees with sample labels? Yes LJ ❑ No <br /> Internal Chain of Custody(COC)requested? Yes ❑ ✓k No <br /> Sub Contract Lab Used None C ❑ SEM Other(see comments) ❑ <br /> Sample Recut Information <br /> Shipping containerlcooler in good condition? Yes LVJ ❑ No Not Presen ❑ <br /> Samples in proper containerlbottle? Yes L El No <br /> Sample containers intact? Yes 0 ❑ No <br /> Sufficient sample volume for indicated test? Yes Fv'� ❑ No <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes IV] ❑ No <br /> Cooler Temperature <br /> Containerlremp Blank temperature in compliance(0-6°C)? Yes [V�_ ❑ No 40C <br /> Water-VOA vials have zero headspace 1 no bubbles? Yes u ❑ No No VOA vials submitted ❑ <br /> TOC Water-pH acceptable upon receipt? Yes ❑ ❑ No NIA V <br /> TOC Samples should have a pH<2(H2SO4) <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested? Yes ❑ D No <br /> Are there client specific Project requirements? Yes ❑ J No If YES see the Chain of Custody(COC) <br /> Comments <br />
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