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ARCHIVED REPORTS_XR0002623
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HARLAN
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3500 - Local Oversight Program
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PR0545273
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ARCHIVED REPORTS_XR0002623
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Entry Properties
Last modified
2/3/2020 7:01:16 PM
Creation date
2/3/2020 11:21:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002623
RECORD_ID
PR0545273
PE
3528
FACILITY_ID
FA0000174
FACILITY_NAME
JOES TRAVEL PLAZA
STREET_NUMBER
15600
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19620079
CURRENT_STATUS
02
SITE_LOCATION
15600 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 5/26/2004 Date of Notice 5/1812004 12 41 44 <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 2033-15600-011Joes Truck Plaza <br /> Project Manager Scott Bittmger Client's Phone (530)676-6008 Client's FAX (530)676-6005 <br /> Work Order Number STR04051845 Date Received 5/1812004 Received by Dolly S Baker - <br /> Chain of Custody(COC)Information <br /> Carrier name FedEx <br /> Chain of custody present Yes n _� No <br /> Custody seals intact on shipppmg contain erlcooler? Yes No Not Present ❑ <br /> Custody seals intact on sample bottles? Yes F] LI No Not Present <br /> Chain of custody signed when relinquished and received? Yes IV—,i ❑ No <br /> Chain of custody agrees with sample labels? Yes ❑ No <br /> Sample ID noted by Client on COC? Yes n ❑ No <br /> Date and time of collection noted by Client on COC? Yes 0 ❑ No <br /> .SampJers's name noted on COC? Yes 1 ❑ No <br /> internal Chain of Custody(COC)requested? Yes ❑ V No <br /> Sub Contract Lab Used None ❑ SENT Other(see comments) <br /> Sample Recin t Information <br /> Shipping container/cooler in good condition? Yes n F_'i No Not Present F 1 <br /> Samples in proper containertbottle? Yes n ❑ No <br /> Sample containers intact? Yes ❑ No <br /> Sufficient sample volume for indicated test? Yes V No <br /> Sample Preservation and Hold Time HT Information <br /> All samples received within holding time? Yes W ❑ No Cooler Temperature <br /> Container/Temp Blank temperature in compliance(0-6°C)7 Yes n ❑ No 4 OC <br /> Water-VOA vials have zero headspace 1 no bubbles? Yes Wd ❑ No No VOA vials submitted ) <br /> Sample labels checked for correct preservation? Yes 1%/1 F ) No <br /> TQC Water-pH acceptable upon receipt(H2SO4 pH<2)? Yes Ll ❑ No NIA l� <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested? Yes ❑ 7 No <br /> Are there client specific Project requirements? Yes FD n No If YES see the Chain of Custody(COC) <br /> 0—omments Some VOA's received broken see Remarks on COC <br />
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