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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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Entry Properties
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
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 911 912 00 3 Date of Notice 9/11/2403 11 18 47 <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 2001-01031 Teichert <br /> Project Manager Jay Johnson Client's Phone (539)676 6000 Client's FAX (530) 676-6005 <br /> Work Order Number STRO3091124 Date Received 9/11/2003 Received by Graciela Navarrete <br /> Chain of Custody(COC) Information <br /> Carrier name FedEx <br /> Chain of custody present? Yes ❑ No <br /> Custody seats intact on shippping container/cooler? Yes ❑ ❑ No Not Presen ❑ <br /> Custody seals intact on sample bottles? Yes ❑ ❑ No Not Presen ❑� <br /> Chain of custody signed when relinquished and received? Yes W ❑ No <br /> Chain of custody agrees with sample labels? Yes R9 ❑ No <br /> Internal Chain of Custody(COC)requested ? Yes ❑ R] No <br /> Sub Contract Lab Used None S6 ❑ SEM Other(see comments) ❑ <br /> Sample Receipt Information <br /> Shipping container/cooler in good condition? Yes 1�5 ❑ No Not Presen ❑ <br /> WsSamples in proper container/bottle? Yes R] El No <br /> ample containers intact? Yes F-21 ❑ No <br /> Sufficient sample volume for indicated test? Yes R] ❑ No <br /> Sam le Preservation and Hold Time HT 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 1 no bubbles? Yes ❑ No No VOA vials submitted ❑ <br /> TOC Water-pH acceptable upon receipt? Yes ❑ ❑ No NIA <br /> TOC Samples should have a pH<2(H2SO4) <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested? Yes ❑ R) No <br /> Are there client specific Project requirements? Yes ❑ ❑ No if YES see the Chain of Custody(COC) <br /> Comments <br /> 0 <br />
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