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ARCHIVED REPORTS_XR0004426
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004426
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Entry Properties
Last modified
2/6/2020 5:01:56 PM
Creation date
2/6/2020 3:35:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004426
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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Argon Laboratories Sample Receipt Checklist <br /> Chem Name U <br /> . —• __ Date&Time Received: U 1 12-00 <br /> Project Name. �U �- M --� <br /> _T. Client Project Number: <br /> Received 8y: <br /> Matrix: Water -" Soil ❑ Other <br /> Sam¢le Carrier Client ❑ Laboratory Fed Ex ❑ ❑ <br /> Argon Lab //�� UPS ❑ Other s Project Number: l-6 U3C} <br /> Shipper Container in good condition? Sufficient sample volume for requested tests?Yes -❑ No ❑ <br /> NIA ❑ Yes ❑ No ❑ Samples received within holding time? Yes No ❑ <br /> Samples received under refrigeration? Yes No ❑ Do samples contain proper preservative? <br /> ❑ � ❑ <br /> Cham of custody present? Yes [ No <br /> ❑ VOA vials with preservative? N/A Yes Na <br /> NIA C1 Yes ,� No ❑ <br /> Cham of Custody signed by aft parties? Yes ET No ❑ VOA vials preservative type: <br /> HCL 2r" Na2S203 ❑ Other <br /> ^,ha n of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes No ❑ NIA ❑ Yes No ❑ <br /> Samples received in proper containers? Yes No ❑ Samples received intact? ❑ <br /> Yes Na <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Client Contacted: Person Contacted: <br /> Contacted By: Subject: <br /> Comments: <br /> Action Taken: <br /> ADDITIONAL TEST(S)REQUEST!OTHER <br /> Contacted By: Date: � ^ <br /> Time: _ <br /> Call Received By: <br /> f nmmnnFc• <br /> v.5.02 <br />
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