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COMPLIANCE INFO_2015-2019
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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.DOC <br /> Revision Date: 10/09/14 Page 1 of 1 <br /> Inter-Labmtory Condition Upon Receipt (Attach to COC) <br /> Sample Receipt at: TK CC CH VI <br /> 1. Number of ice chests packages received: Shipping tracking# <br /> 2. Were samples received in a chilled condition? Temps: 6•" / / <br /> Surface water SWTR 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.) fes <br /> No <br /> 5. VOAs checked for Headspace? 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 Tte <br /> No <br /> Sign and date the COC, place in a ziplock and put r t e ame ice chest ples. <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 6+'0►C. If many packages are received at one time check for tests/H.T.'s/rashes/ <br /> 2. Shippin trpckin numbers: <br /> A 3V 07 <br /> 5 1�- <br /> 3. Do the number of bottles received agree with the COC? C Y No N/A <br /> 4. Were samples received intact?(i.e. no broken bottles, leaks etc.) e No <br /> 5. Were sample custody seals intact? Yes No 613 <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? *es <br /> No <br /> 3. Were all bottles requiring sample preservation properly preserved? No FGL <br /> (Exception:Oil&Grease,VOA and CM verified in labl <br /> 4. VOAs checked for Headspace? Yes No <br /> 5. Have rush or project due dates been checked and accepted? Yes No IZA� <br /> 6. Were all analyses within holding times at time of receipt? � 0 <br /> Attach labels to the containers and include a copy of the COC for lab delive . <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: <br /> (3-13723) <br /> 2. Person Contacted: Ron Hittle <br /> Initiated By: <br /> Problem: STK 19 3 2 6 5 9 <br /> Resolution: <br /> APB-02/25/2019-15:29:49 i <br /> (Please use the back of this sheet for additional commt...... .r <br /> contacts) —- —-- <br />
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