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ARCHIVED REPORTS_XR0002238
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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GRANT LINE
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574
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3500 - Local Oversight Program
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PR0545205
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ARCHIVED REPORTS_XR0002238
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Entry Properties
Last modified
1/27/2020 3:47:34 PM
Creation date
1/27/2020 3:17:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002238
RECORD_ID
PR0545205
PE
3528
FACILITY_ID
FA0003164
FACILITY_NAME
NORTH POLE GAS & FOOD INC
STREET_NUMBER
574
Direction
W
STREET_NAME
GRANT LINE
STREET_TYPE
RD
City
TRACY
Zip
95376
CURRENT_STATUS
02
SITE_LOCATION
574 W GRANT LINE RD
P_LOCATION
03
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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t� <br /> � 1L yak <br /> 0} - MEN <br /> Sample Receipt Checklist STL San Francisco <br /> Submission #: 2002- - _ 6VqZ_-- <br /> Checklist completed by (initials) Date X 1102 <br /> Couner name ❑ STL San Francisco Client <br /> Not / <br /> Custody seals intact on shipping container/samples Yes Na Present 1/ <br /> Cham of custody present? Yes No <br /> Chain of custody signed when relinquished and received? Yes ✓ No <br /> Chain of custody agrees with sample labels? Yes__No <br /> Samples in proper container/bottle? Yes ✓ No <br /> Sample containers intact? Yes `� No <br /> Sufficient sample volume for indicated test? Yes /No <br /> All samples received within holding time? � Yes No <br /> Contamer/Temp Blank temperature in compliance (40 C*2)? Temp /'l,e.c Yes `r No <br /> 10 Water-VOA vials have zero headspace? No VOA vials submitted/Yes No <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as 5 (small—O), M (medium — O)or L(large— O) <br /> Water-pH acceptable upon receipt? ❑ Yes ❑ No <br /> ❑ pH adjusted— Preservative used ❑ HNO3 ❑ HCl ❑ H2SO4 ❑ NaOH ❑ZnOAc <br /> For any item check-listed "No", provided detail of discrepancy in comment section below <br /> Comments <br /> Project Management [Routing for instruction of indicated dlscrepancy(ies)] <br /> Project Manager (Initials) Date 1 102 <br /> Client contacted El Yes ❑ No <br /> Summary of discussion <br /> 18 <br /> Corrective Action (per PM/Client) <br />
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