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ARCHIVED REPORTS XR0006298
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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 XR0006298
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Entry Properties
Last modified
10/18/2019 9:16:59 AM
Creation date
10/18/2019 9:10:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006298
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 /> SECQR Chain-of Custody RecordNow <br /> Field Office 077 Sacramento E3 Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road, Suite 100 Job Name 7-Eleven Store#17647 <br /> Rancho Cordova, CA Location 1048 West Yosemite Ave <br /> Manteca, California <br /> Project# 77EL 17647 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Kiff Analytical <br /> W <br /> Turnaround Time Standard a v <br /> a x h A m <br /> o <br /> Sampler's Name Tom Miller x .20 <br /> _ o 2 � " Y <br /> Sampler's Signature o m U N '91a o N <br /> _ <br /> a m �° <br /> Time Matrix O <br /> Comments/ID Date m N a <br /> � � ( _ 10 <br /> co w r- w Instructions z <br /> MW-1 y/ �, i 3 or Water X X y/ <br /> MW-2 _� -4� i 3Yv Water X <br /> X V <br /> MWS t/ /7-,,3 1'.5 20 Water X X <br /> I <br /> Special Instructions/Comments Relinquished by i�"' ived by -Sample Receipt <br /> 7 Oxygenates TAME, MtBE, EtBE,TBA, DIPS, EDB & Sign Sign Total no of containers <br /> 1,2 DCA Print 7 i /�� Print Chain of custody seats <br /> Global ID#T0607700351 (SIRC) Company �=4 Company Rec'd in good condition/cold <br /> EDF Deliverables- Email Molly Koch at Time 14 lS Date g p Tim Date Conforms to record <br /> mkoch@secor.com uished by Received by <br /> email results to bcarey@secor com :Print <br /> Sign _ Client SECOR <br /> Print sClientContact BrianCarey <br /> Company Client Phone 916 861-MG <br /> Date Time tyj9 Date d o ext. 241 <br /> SECOR CUSMEC Rev 2M <br /> Date /-/>-c, 3 Page <br />
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