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ARCHIVED REPORTS XR0004307
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0544686
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ARCHIVED REPORTS XR0004307
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Entry Properties
Last modified
7/23/2019 11:39:13 AM
Creation date
7/23/2019 11:26:25 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004307
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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SJGOV\wng
Tags
EHD - Public
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Acculabs Inc. Lab Number r <br /> [ ] 1725 W 17th St Tempe AZ 85281 602-967-1310 Fax 967-1019 <br /> [ ]4455 S Park Ave Tucson AZ 85714 520-807-3801 Fax 807-3803 Report <br /> [ ]2020 W Lone Cactus Dr Phoenix AZ 85027 602-780-4800 Fax 780-7695 Due Date <br /> 1 ( ]2029 N 4th St Flagstaff AZ 86004 520-774-7643 Fax 774-7648 <br /> 46 Olive Drive Davis CA 95616 530-757-0920 Fax 753-6091 <br /> ]75 Suttle St Durango CO 81301 970-247-4220 Fax 247-4227 <br /> [ }4663 Table Mountain Dr Golden CO 80403 303-277-9514 Fax 277-9512 <br /> [ ]992 Spice Islands Dr Sparks NV 89431 702-355-0202 Fax 355-0817 <br /> Client PUBLIC WATER SUPPLY INFORMATION <br /> 1 Addres System Report to State Y N <br /> City State&ZipC6141r17jCn C4 <br /> I PWS No Report to EPA Y N <br /> Contac POE No DWR No <br /> Protect Nam 6 Collection Point <br /> F J Protect Number-I Collector's Name <br /> 1 <br /> IP 0\-Number Fax Results Y N Page of Location(City) <br /> SAMPLE TYPE CODES Analyses <br /> DW=drinking water TB=travel blank Compliance S C Requeste <br /> waste water SD=solid Monitoring a o <br /> = <br /> M n <br /> -monitonng well SO=soil Y N P t <br /> HW=hazardous waste SL=sludge I a <br /> TURNAROUND TIME REQUESTED e i <br /> n <br /> rtandard Lab Manager T e <br /> Approval y r <br /> P s <br /> a <br /> 1 <br /> CLIENT'S SAMPLE IDILOCATION Date Time Spl No <br /> •- o oI <br /> - 2 <br /> S- 1� WL <br /> 03 <br /> 1 C� <br /> 1-30 <br /> 1 W , I Z.. I CAL Cb <br /> Kw-IA 0 <br /> Instructions/Comments/Special Requirements <br /> 1 SAMPLE RECEIPT Date Time I S pies Relinquished By Samplejs Received B <br /> ' Received Cold Y N �Zd <br /> ustody Seals Y N <br /> als Intact Y N <br /> 1#No of Containers <br /> Acculabs'terms are Net 40 (Payment must be received by the date shown on the Invoice or any discount is void) <br /> 1 <br />
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