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ARCHIVED REPORTS_XR0004431
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004431
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Last modified
2/6/2020 5:04:23 PM
Creation date
2/6/2020 3:38:50 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004431
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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Ar on Laboratories Sample Receipt Checklist <br /> . <br /> Client Name: C�.rLb�. 1 <br /> t� t�G41u 0 oG E5 Date&Time Received: 1 -2-(,.,.,1 03 <br /> Project Name: Client Project Number: 3 , <br /> Received By: <br /> Matrix: Water Soil 1 <br /> Sample Carrier: Client 1 aborata 1 edEx 1 UPS 1 <br /> Argon tabs Project Number: <br /> Shipping Container 1 Cooler in good condition? Samples received in proper containers? Yes ✓ No <br /> WA ✓Yes No Samples received intact? Yes Lf'-No <br /> Samples received under refrigeration? Sufficient sample volume for requested tests? <br /> Yes ✓ No Yes ✓No <br /> Chain of Custody Present? Yes �No Samples received within holding time? Yes ✓No <br /> Chain of Custody signed by all parties? Do samples contain proper preservative? <br /> Yes fNo NIA Yes '�Na <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero headspace? / <br /> Yes No (None submitted____)Yes ✓ No <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 /> OTHER <br /> Date ClientContacted: Person Contacted: <br /> Comments: <br />
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