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ARCHIVED REPORTS_XR0004434
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004434
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Entry Properties
Last modified
2/6/2020 4:56:16 PM
Creation date
2/6/2020 3:40:03 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004434
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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SJGOV\wng
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EHD - Public
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Ar on Laboratories Sample Receipt Checklist <br /> Client Name <br /> d `� u � Date&Time Received: 3-5 <br /> Project Name: Cy -, <br /> Client Project Number: <br /> Received By: x.C- Matrix: W er / Soil / <br /> 1 � <br /> Sample Carrier: Client 1 Labor4tory1 FedEx 1 UPS 1 <br /> Argon Labs Project Number: ` 3c) l <br /> Shipping Container 1 Cooler in good condition? Samples received in proper containers? Yes No <br /> ' N/A-I—Yes No Samples received intact? Yes No <br /> Samples received under refrigeration? Sufficient sample volume for requested tests? <br /> Yes No Yes No <br /> Chain of Custody Present? Yeses,_ No Samples received within holding time? Yeses No <br /> Chain of Custody signed by all parties? Do samples contain proper preservative? <br /> Yes-7 No NIA YesA No <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> ' Yes y 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 Client Contacted: Person Contacted, <br />: r <br /> vvi i u i reiits: <br /> w <br />
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