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ARCHIVED REPORTS_XR0003853
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545420
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ARCHIVED REPORTS_XR0003853
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Entry Properties
Last modified
3/5/2020 5:53:46 PM
Creation date
3/5/2020 4:36:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003853
RECORD_ID
PR0545420
PE
3528
FACILITY_ID
FA0003815
FACILITY_NAME
TESORO (SPEEDWAY) 68154
STREET_NUMBER
2500
Direction
W
STREET_NAME
LODI
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
02740006
CURRENT_STATUS
02
SITE_LOCATION
2500 W LODI AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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II <br /> Alpha Analytical, Inc. <br /> Phone: (775)355-1044 FAX:(775)355-0406 <br /> Sample Receipt Checklist <br /> Date Report is due to Client: 4/20/2004 Date of Notice: 4112120048:39:02A <br /> j 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'iEnvironmental Project ID: USA 65 <br /> Project Mana er: Gowri Kowtha <br /> 1 g Client's Phone (530)676-6002 Client's FAX (530)676-6005 � <br /> Work Ortler Number: STR04041240 Date Received:411012004 Received by: Dolly S. Baker <br /> Chain of Custody(COC) Information I <br /> f _ k <br /> Carrier name FedEx <br /> Chain of pustody present? Yes !�/� I_J No <br /> Custody seals intact on shippping container/cooler? Yes h/� No Not Present <br /> 'i. <br />! Custody seals intact on sample bottles?. Yes No Not Present C! <br /> Chain of custody signed when relinquished and received? Yes W ❑ No <br /> Chain of custody agrees with sample labels? Yes No <br /> Sampie ID noted by Client on COC? Yes No <br /> � k <br /> Date and!time of collection noted by Client on COC? Yes h!t ❑ No <br /> „ t <br /> Q <br /> amplers's name noted on COC? Yes L] ❑ No <br /> nternal Chain of Custody(COC)requested? Yes "L_! FV! No <br />€ Sub Contract Lab Used: None � ❑ SEM Other(see comments) <br /> a Sample Receipt Information <br /> Shipping container/cooler in good condition? Yes Wil I__J No Not Present l_I <br /> 4 ! <br /> Samples in proper confainerlbottle? Yes � ! No <br /> Sample containers intact? j Yes I EJ No <br /> SufficientLsample volume for indicated test? Yes ❑ ❑ No <br /> li Sample Preservation and Hold Time(HTJ Information <br /> 'I <br /> All samples received within holding time? Yes ❑ No <br /> Cooler Temperature <br /> Container Temp Blank temperature in compliance(0-6°C)? Yes I-/J F No 4°C <br /> Water-VOA vials have zero headspace 1 no bubbles? Yes ill ❑ No No VOA vials submitted (� <br /> Sample labels checked for correct preservation? Yes W1 No <br /> ' l <br /> 3 <br /> TQC Water-pH acceptable upon receipt(H2SO4 pH<2)?, Yes F-1 1 ❑ No N/A n%' <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested? Yes No <br /> ii <br /> Are there client specific Project requirements? I Yes ❑ E' No If YES :see the Chain of Custody(COC) <br /> :1 <br /> in 4!12104. <br /> omments: Samples received 4110104,samples kept cold&secure until log <br /> I <br /> i! <br /> i� <br /> ,k <br /> I <br /> E <br />
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