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ARCHIVED REPORTS_XR0004425
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004425
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Last modified
2/6/2020 4:42:16 PM
Creation date
2/6/2020 3:33:16 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004425
RECORD_ID
PR0545347
PE
3528
FACILITY_ID
FA0003685
FACILITY_NAME
DBA CIRCLEK, REFUEL PETROLEUM INC.
STREET_NUMBER
419
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21938610
CURRENT_STATUS
02
SITE_LOCATION
419 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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1 1 <br /> Amon Laboratories Sample Recei t Checklist <br /> Client Name: Condor Earth Technologies Date&Time Received: 06/29/06 14:46 <br /> Project Name: Ba rLeEte Manteca � _ Client Project Number: 3761 D <br /> Received By: H.C. Matrix: Water ❑ Soil ❑ Sludge ❑ <br /> Sample Carrier: Client ❑ Laboratory ❑ Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon tabs Project Number: G606092 <br /> Shipper Container in good condition? Samples received In proper containers? Yes Q No ❑ <br /> WA_ __ Yes [] No ❑ Samples received Intact? Yes No ❑ <br /> Samples received under refrigeration? Yes ❑ No ❑ Sufficient sample volume for requested tests?Yes ❑ No ❑ <br /> Chain of custody present? Yes No ❑ Samples received within holding time? Yes No ❑ <br /> Chain of Custody signed by all parties? Yes No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes No ❑ <br /> Chain of Custody matches all sample labels? Do VOA vias contain zero headspaee? <br /> Yes No ❑ (None submitted ❑) Yes Q No ❑ <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> .Client Contacted: Person Contacted: <br /> Contacted By: Subject: <br /> Cclnrnents: <br /> Action Taken: <br /> ADDITIONAL TEST(S)REQUEST 1 OTHER <br /> Contacted Sy: Date: Time; <br /> Call Received By: <br /> Comments: <br />
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