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COMPLIANCE INFO_2015-2019
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1600 - Food Program
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PR0539648
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COMPLIANCE INFO_2015-2019
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Entry Properties
Last modified
10/7/2020 1:43:57 PM
Creation date
7/24/2019 11:49:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2015-2019
RECORD_ID
PR0539648
PE
1609
FACILITY_ID
FA0022688
FACILITY_NAME
RUSTIC CRUNCH
STREET_NUMBER
3958
Direction
W
STREET_NAME
SARGENT
STREET_TYPE
RD
City
LODI
Zip
95242
APN
02514003
CURRENT_STATUS
01
SITE_LOCATION
3958 W SARGENT RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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FGL Environmental Doc ID:3DO900002_SOP_12-1.DOC <br /> Revision Date: 10/09/14 Page 1 of 1 <br /> Inter-L"tory Condition Upon Receipt (Attach to COC) I K319-38 <br /> Sample Receipt at: ST CC CH VI <br /> 1. Number of ice chests/packages received: Shipping tracking# <br /> 2. Were samples received in a chilled condition? Temps: —JZIF / 7, / / / <br /> Surface water SVM bact samples:A sample that has a temperature upon receipt of >10°C,whether iced or not, <br /> should be flagged unless the time since sample collection has been less than two hours. <br /> 3. Do the number of bottles received agree with the COC? No N/A <br /> 4. Were samples received intact? (i.e.no broken bottles, leaks etc.) Yes No <br /> 5. VOAs checked for Headspace? Yes No <br /> 6. Were sample custody seals intact? Yes No <br /> 7. If required, was sample split for pH analysis? Yes No <br /> 8. Were all analyses within holding times at time of receipt? No <br /> 9. Verify sample date, time and sampler name Yes No <br /> Sign and date the COC,place in a ziplock and put in th a ice chest as the samples. <br /> Sample Receipt Review completed by(initials): <br /> Sample Receipt at SP: <br /> 1. Were samples received in a chilled condition? Temps: <br /> Acceptable is above freezing to 6A C. If many packages are received at one time check for tests/H.T.'s/rushest <br /> 2. Shipping tracking numbers: <br /> 3. Do the number Djles received agree with the COC? No N/A <br /> 4. Were samples received intact? (i.e. no broken bottles, leaks etc.) No <br /> 5. Were sample custody seals intact? Yes No t/ <br /> Sign and date the COC, obtain LIMS sample numbers, select methods/tests and print labels. <br /> Sample Verification, Labeling and Distribution: <br /> 1. Were all requested analyses understood and acceptable? No <br /> 2. Did bottle labels correspond with the client's ID's? e No <br /> 3. Were all bottles requiring sample preservation properly preserved? Yes No /0 FGL <br /> [Exception:Oil&Grease,VOA and CrVI verified in lab] <br /> 4. VOAs checked for Headspace? Yes No Q <br /> 5. Have rush or project due dates been checked and accepted? Y No <br /> 6. Were all analyses within holding times at time of receipt? es No <br /> Attach labels to the containers and include a copy of the COC for lab delivery. ( <br /> Sample Receipt, Login and Verification completed by(initials): (- <br /> Discrepancy Documentation: <br /> Any items above which are"No"or do not meet specifications(i.e. temps)must be resolved. <br /> 1. Person Contacted: Phone Number: <br /> Initiated By: Date: <br /> Problem: <br /> Resolution: (3-13723) <br /> D�,l 111VI+,1� <br /> 2. Person Contacted: <br /> Initiated By: S TK 18 3 18 3 8 <br /> Problem: <br /> Resolution: IV-02/12/2018-16:04:50 <br /> (Please use the back of this sheet for additional comments or T Atiac7i Iabe1 wiffila6nuinber here <br /> contacts) <br />
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