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ARCHIVED REPORTS_XR0007424
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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P
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PACIFIC
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6131
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3500 - Local Oversight Program
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PR0545003
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ARCHIVED REPORTS_XR0007424
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Last modified
11/27/2019 11:38:59 AM
Creation date
11/27/2019 11:22:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007424
RECORD_ID
PR0545003
PE
3526
FACILITY_ID
FA0002324
FACILITY_NAME
Pacific Service Station
STREET_NUMBER
6131
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09746418
CURRENT_STATUS
02
SITE_LOCATION
6131 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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COOLER RECEIPT FORM <br />�j ect: 0.�}����.'Z- 1P . Log No: <br /> lar receive on: \NV\jkV and checked on by <br /> szgna ure <br /> Mere custody papers present? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..I'M NO <br /> Were custody papers properly filled out > . . . . . . . . . . . . . . . . . . . YES NO <br /> Were the custody papers signed? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y-Es NO <br /> 0 <br /> was sufficient ice used"' . . . . . . . . . . . . . . . . . . . . . . . . . . . .YES- NO�- <br /> Did all bottles arrive in good condition (unbroken) ? . . . . . . .Y-25 NO <br /> Did bottle labels match COC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..mss NO <br /> Were proper bottles used for analysis indicated? . . . . . . . . . . .Y-E,-� NO <br /> Correct preservatives used" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y -% NO <br /> VOA vials checked for headspace bubbles? . . . . . . . . . . . . . . . . . . .Y-Fra NO <br /> Note which voas ( if any) had bubbles: * <br /> Simle descriptor: Number of vials: <br /> I <br /> *All VOAs with headspace bubbles have been set aside so they will not be <br /> usedfor analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO <br /> List here all other fobs received in the same cooler: <br /> Client Job # NET log # <br /> (coolerrec) <br />
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