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ARCHIVED REPORTS XR0004294
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3500 - Local Oversight Program
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PR0544686
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ARCHIVED REPORTS XR0004294
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Entry Properties
Last modified
7/23/2019 11:48:22 AM
Creation date
7/23/2019 11:19:50 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004294
RECORD_ID
PR0544686
PE
3528
FACILITY_ID
FA0000916
FACILITY_NAME
7-ELEVEN INC #19976
STREET_NUMBER
1399
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21633034
CURRENT_STATUS
02
SITE_LOCATION
1399 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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0 Chain of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento L3 Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#19976 <br /> Rancho Cordova,CA Location 1399 North Main Street <br /> Manteca,CA <br /> Project# 77EL.19976 05 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Kiff Analytical ;, e <br /> Turnaround Time Standard d = n Wm <br /> W 0 g a [7 a o <br /> Samplers Name �/� 5 0 a e en- <br /> CL <br /> o g o o a <br /> Sampler's Signature a m g m N m T ti r; <br /> = E g e 4 Comments) <br /> Sample ID Date Time Matrix = a I m x w n m go W Instructions z <br /> MW-1 -1D -AS Water x X X 3 01 <br /> MWAA Z-5.5 Water x X X 3 02 <br /> MW-2 t Water x X X 3 °' <br /> MW-3 to wl Water x X X 3 04 <br /> MW-5 1 yyS Water x X X 3 05 <br /> MW-5A Water x X X g 06 <br /> " MW-6 121Water x X X 3 07 <br /> MW-7 ►iWater x X X 3 a$ <br /> Special InstructionsfComments Relinquished by VA Received by Sample Receipt <br /> 5 Oxygenates,TAME,MtBE,EtBE,TBA,DIPE Sign Sign Total no of containers <br /> Global ID#70607700750(SIRC) Print Print Chain of custody seals <br /> email EDD to dacatlln@secor.com Company Seer Com —71edd in good condroonlcold <br /> email lab report to dherzog@secor.com and Time Date Ti a Date Conforms to record <br /> tmiller@secor corn Relinquished by Received bT <br /> Sign Sign Client SECOR <br /> PnntPrint re.+ Client Contact <br /> Com Company W ff 4,'e.f Client Phone (916)861-0400 <br /> e Dake Time 14045 Date as I I o S ext.279 <br /> Date Z-Io-ESS Page i <br />
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