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ARCHIVED REPORTS XR0004302
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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 /> Field Office 077 Sacramento _ 0 Additional documents are attached,and are part of this Record <br /> Address 301710gor+e Road,Suite 100 Job Name 7-Eleven Stone 932262 <br /> Rancho Cordova,CA Location 1399 North Main Street <br /> Manteca,Califnrnla <br /> Protect# 77EL19976.43 Task# 0410 Analysis Request <br /> Project Manager Jalf Auchtedonie <br /> Laboratory Klff Analytical 8 <br /> Turnaround Time 24 Hour <br /> Sampler's Name I r d ft m 4 m 0 0 <br /> Samplers Signature " a <br /> Comments/ <br /> Sample ID Date Time Matrix = 1.- 11--m m > m Instructions z <br /> SBS I-D Soil X 4 <br /> SBfr LAND .�L L q3 Soil X 4 <br /> I <br /> Special Instructions/Comments Relinqui ed 1 44 Received by Sa le Rempt <br /> Combine discrete samples SP-4(A),SP-4(B),SP-4(C), Sign AAA Sign Total no of containers <br /> &SP-4(0)Into cornpos[te sample SP-4(ABCD). Print ; c Print Chain of custody seats <br /> Company SEC R Company Recd in good eoridrhordcold <br /> Combine discrete samples SP-5(A),SP-5(B),SPS(C), Time ILhL-Pate - -0 Time Date Confnmss to record <br /> &SP-0(0)Into composlte sample SP-(ASCD). Relinquished by Received by <br /> Sign Sign Client: SECOR <br /> emali results to Jauchterionle@secor com Print Print r w T5.77 Client Contact Jaff Auchtwlonle <br /> cc results to:dacadln@secor.com Company Company Klff Anal)6"[ Client Phone (916)861-0400 <br /> Time Date Time &4 Date zfext,223 <br /> Date Page 1 1 <br />
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