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ARCHIVED REPORTS_XR0007427
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_XR0007427
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Last modified
11/27/2019 11:38:48 AM
Creation date
11/27/2019 11:23:42 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007427
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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s <br /> _ x <br /> COOLER RECEIPT FORM <br /> Kro]ect: ro05i[,� -& — _ Log No: <br /> ooler received on. and c ec e on -I by <br /> sz aur <br /> Were custody papers present? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E NO <br /> F <br /> Were custody papers properly filled out? . . . . . . . . . . . . . . . . . . 0NO <br /> Were the custody papers signed? . . . . . . . . . . . . . . . . . . . . . . . . . . E NO <br /> Was sufficient ice used"' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y NO dofe � <br /> Did all bottles arrive in good condition (unbroken) ? . . . . . . . INO NO <br /> Dial bottle labels match COC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y <br /> Were proper bottles used for analysis indicated? . . . . . . . . . . .�.E NO <br /> Correctpreservatives used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO <br /> VOA vials checked for headspace bubbles? . . . . . . . . . . . . . . . . . . NO <br /> Mote which voas (i£ any) had bubbles: * <br /> Sample descriptor: Number of vials. <br /> dwnn <br /> *All VOAs with headspace bubbles have been set aside so they will not be <br /> used for analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO <br /> List here all other fobs received in the same cooler: <br /> Client Job I NET log , <br /> (coolerrec) <br />
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