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3500 - Local Oversight Program
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PR0545274
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Last modified
1/31/2020 6:05:52 PM
Creation date
1/31/2020 4:38:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545274
PE
3528
FACILITY_ID
FA0018313
FACILITY_NAME
JOES TRAVEL PLAZA
STREET_NUMBER
15688
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19620077
CURRENT_STATUS
02
SITE_LOCATION
15688 S HARLAN RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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Alpha Analytical, Inc. <br /> Phone:(775)355-1044 FAX:(775)355-0406 <br /> Sample Receipt Checklist <br /> Date Report is due to Client: 7/29/2009 Date of Notice: 7/22/2009 10:09:04 <br /> Please take note of any NO check marks.If we receive no response concerning these items within 24 hours of the date of this notice,all of <br /> the samples will be analyzed as requested. <br /> Client Name: Stratus Environmental Project ID: 2033-15088-01/City of Lathrop <br /> Project Manager: Sarah Salcedo Client's EMail: ssalcado@stratusinc.net <br /> Client's Phone: (530)313.9966 Client's FAX: (530)676-6005 <br /> Work Order Number: STR09072252 Date Received: 7/22/2009 Received by:Tara Dickinson f <br /> Chain of Custody(COC)Information <br /> Carrier name FedEx <br /> Chain of custody present? Yes No <br /> Custody seals intact on shippping container/cooler? Yes ❑ ❑ No Not Present ❑ <br /> Custody seals intact on sample bottles? - Yes ❑ ❑ No Not Present <br /> Chain of custody signed when relinquished and received? Yes 0 ❑ No <br /> Chain of custody agrees with sample labels? Yes (] ❑ No <br /> Sample ID noted by Client on COC? Yes 0 ❑ No <br /> { <br /> Date and time of collection noted by Client on COC? Yes s - ❑ No <br /> Samplers's name noted on COC? Yes. (] ❑ No <br /> Internal Chain of Custody(COC)requested? Yes ❑ No <br /> Sub Contract Lab Used : None ❑ See Comments <br /> Sample Receipt Information <br /> Shipping container/cooler in good condition? C Yes ❑ No Not Present ❑ <br /> Samples in proper container/bottle? Yes ❑ No <br /> Sample containers intact? Yes © ❑ No fi <br /> Sufficient sample volume for indicated test? Yes ❑ No .` <br /> Sample Preservation and Hold Time(HT)Information <br /> All samples received within holding time? Yes ❑ No <br /> Cooler Temperature <br /> Contamer/Temp Blank temperature in compliance(0-6"C)? Yes ❑ No 40C <br /> Water-VOA vials have zero headspace/no bubbles? Yes ❑ ❑ No N/A ❑ No VOA vials submitted <br /> i <br /> Sample labels checked for correct preservation? Yes (] ❑ No <br /> TOC Water-pH acceptable upon receipt(H2SO4 pH<2)? Yes ❑ ❑ No N/A <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested? Yes ❑- W No <br /> Are there client specific Project requirements? Yes No If YES:see the Chain of Custody(COC) <br /> Comments: - C <br /> f <br /> I <br /> i <br /> p� <br /> ' P <br />
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