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ARCHIVED REPORTS XR0006296
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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Y
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YOSEMITE
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1048
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3500 - Local Oversight Program
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PR0544939
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ARCHIVED REPORTS XR0006296
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Entry Properties
Last modified
10/18/2019 9:17:08 AM
Creation date
10/18/2019 9:10:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006296
RECORD_ID
PR0544939
PE
3528
FACILITY_ID
FA0000508
FACILITY_NAME
7-ELEVEN INC #17647
STREET_NUMBER
1048
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95337
APN
21903003
CURRENT_STATUS
02
SITE_LOCATION
1048 W YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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Chain of Custody Number <br /> SECOR Chain-of Custody Record c`j q\M <br /> Field Office 077 Sacramento C3 Additional documents are attached,and are part of this Record <br /> Job Name 7-Eleven Store#17647 <br /> Address 3017 Kil lore Road,Suite 100 Location 1048 West Yosemite Ave <br /> Rancho Cordova,CA Manteca,Califomia <br /> EL 17647 03 Task# 0410 Analysis Request <br /> Protect# 77 i <br /> Protect Manager Jaff Auchterlonle 8 e <br /> Laboratory Kiff Anai cal 9 _ m v, m r <br /> c49 <br /> Turnaround Time Standard 0 <br /> u, p g <br /> 20 <br /> Sampler's Name T Miller g m o e o o 0 o p m $ <br /> Sampler's Signature E a m N m > Comments/ E <br /> Instructions Z <br /> Sample ID Date Time Matnx x ° co m= E. fair-- w <br /> 7 ♦G/o3 / 3 3o Water X x <br /> Mw-1 02 <br /> s Water x X <br /> Mw-2 r az <br /> MWS <br /> 3 oc Water X X <br /> Relinquished by 1 /fit Received by Sample Receipt <br /> Special instructions/Comments l Sin Total no of containers <br /> 7 Oxygenates TAME,MtBE,EtBE,TBA,DIPE,EDB& gPrini ��� — Pnnt Chain of custody seals <br /> 1,2 DCA Com Recd in good condition/cold <br /> Global ID#T060TT00351 (SIRC) Company S' Conforms to record <br /> Time tt�Date 7 T e Date <br /> EDF Deliverables-(email EDF to mkoch@secor corn) Reoe+ved by <br /> email lab report to dhemog@secor com Relinquished by Sign Client SECOR <br /> Sign <br /> pnnt <br /> Print � l:- Client Contact Bnan Carey <br /> Comp Company Client Phone 916 861-WO <br /> Tim DateTime l te� ext 241 <br /> s a,sr�c am vco Date / Page rb r/ <br />
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