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ARCHIVED REPORTS XR0004302
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0544686
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ARCHIVED REPORTS XR0004302
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Entry Properties
Last modified
7/23/2019 11:53:14 AM
Creation date
7/23/2019 11:24:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004302
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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Chain of Custody Number <br /> SECOR Chain-of Custody Record <br /> Feld Office 077 Sacramento U Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgore(load Suite 100 Job Name 7-Eleven Store#19976 <br /> Rancho Cordova CA Locabon 1399 North Main Street <br /> Manteca California <br /> Project# 77EL.19976.43 Task# 0410 Anal sis Request <br /> Project Manager Jaff Auchterlonle <br /> Laboratory Kiff Analytical m e <br /> Turnaround Time aM.ft <br /> Samplers Name Brian Carey il 11 m <br /> Samplers Signature s S g <br /> 1 < Comments/ <br /> Sample ID Date Time Matrix x r g $ U) W W <br /> Instructions z <br /> -�el P. 06/09/03 tS(5 Soil X Ix X 11 <br /> SP 3 <br /> I-L-L I-T <br /> Special Instrucbons/CommentsRelinqui ed by Received by Sample Receipt <br /> 5 Oxygenates TAME, MtBE, EtBE,TINA,&DIPE Sign Sign Total no of containers <br /> email results to lauchterlonieftecor corn Print Brian Ca Print Chain of custody seals <br /> cc results to dacatli Osecor.com Company SECOR Compan Rec'd in good condition/cold <br /> Co mb i ke- SvnPag,S S Pa R 4-Sp-13 %n'Fa Time '$ Date Time Date <br /> t)r� Crernpo5��-e sAmp12 SQa��g�, Sa►� � Conforms torecord <br /> w i+h SPZ>!Fd f3 q-- sP3�}q.(�r Relinquished by Received b <br /> Sign Sign giant SECOR <br /> Print Print Client Contact Jaff Auchterlonle <br /> Comps Company Kiff Analytical Client Phone 916 861:-0430 <br /> Ti n Date Time Date f>_ QCT ext 223 <br /> SEcogalBTWCHN 2w <br /> Date 5127103 Page 1 of I <br />
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