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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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Cham of Custody Number <br /> 333.53 <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento a 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 California <br /> Project# 77EL19976.43 Task# 0410 Ana sis Request <br /> Project Manager Jaff Auchtedonie <br /> Laboratory Kiff Analytical <br /> Tumaround Time Standard e e <br /> Sampler's Name Danielle Ca In-W ht o m <br /> Sampler's Signature a s e4 o c <br /> ° x 1 s c Comments/ <br /> Sam le ID Data Time Matn m CL W <br /> InstructionsLI Z <br /> Osawosl %V53 Sail I x x x d <br /> 1 � <br /> Special Instructions/CommentsReltn cashed by Received by Sample Receipt <br /> 5 Oxygenates-TAME,MOE, EtBE,TBA,&DIPE Sign ign Total no of containers <br /> email results to Jauchtertonie0secor.com Print Danielle Catlin-Wright( Print Chain of custody seals <br /> cc results to:dacatlinQsecor.com Company SECOR Company Recd in <br /> good conditwNcotd <br /> Time Datedso Time Date Conforms to record <br /> i <br /> Relinquished by ecei <br /> Sign Sign Client SECOR <br /> Print Print Client Contact Jaff Auchterlonle <br /> Compa Company Klff Analytical Client Phone J91D 861-0430 <br /> Date Time ctc"Oq Date oS m ext.223 <br /> «WfMCRw <br /> Date 5/27/0$ Page 7 of 1 <br />
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