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ARCHIVED REPORTS_XR0009177
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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PERSHING
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3500 - Local Oversight Program
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PR0545651
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ARCHIVED REPORTS_XR0009177
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Entry Properties
Last modified
5/6/2020 11:39:36 AM
Creation date
5/6/2020 11:21:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009177
RECORD_ID
PR0545651
PE
3528
FACILITY_ID
FA0002479
FACILITY_NAME
7-ELEVEN INC #17334
STREET_NUMBER
4501
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11017004
CURRENT_STATUS
02
SITE_LOCATION
4501 N PERSHING AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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LSauers
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EHD - Public
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Chain of Custody Number <br /> SECOR Chain-of Custody Record <br /> FFieldOffice 077 Sacramento U Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore RoadSuite 100 Jab Name 7-Eleven Store#17334 <br /> Rancho Cordova CA Location 4501 North Pershing Avenue <br /> Stockton, CA <br /> Project# 77EL 17334 03 Task# 0410 Analysis Request <br /> Project Manager Jafl Auchterlonle <br /> Laboratory Kiff Ana -cal _ m <br /> Turnaround Time Standard a2, = to <br /> oo <br /> Sampler's Name Tom Miller �, o " '� c� <br /> Sampler's Signature N N m N ° <br /> o2 � T <br /> n = z z 8° x m a Comments/ <br /> Sample ID DateTime Matrix ¢ g �, ° r Instructions z' <br /> MW 2 $-/`Y03 [33o Water X X 51 <br /> MW-3 T_-6f /yI s Water X X y <br /> MW-4 9'-61-03 ASW Water X X <br /> MW5A YVY Y=/Y03 Water X X [� <br /> MW-5B 63 Water X X <br /> I <br /> Special Instructions/Comments Relinquished by 7 �l il�r� Received by Sample Receipt <br /> 5 Oxygenates. TAME, MtBE, EtBE,TBA, DIPE Sign Sign Total no of containers <br /> Global ID#T0607700407(SIRC) Print Print Chain of custody seals <br /> EDF Deliverables(email to mkoch@secor com) Company -7,- Company Rec'd in good condition/cold <br /> email results to dherzogOsecor.com Time t7cv�- Date Q-r,-a3 Ti Date Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client SECOR <br /> Print Print Mittel e wr�AAjeh,, Client Contact Brian Care <br /> GoCompany _�f� „�„c.,�c Client Phone (918)881-0400 <br /> Ti mpan Date Time i ct7 Date ey,Sa3 ext 241 <br /> SECOR CUSiREC Rev 2199 <br /> Date Page �o,c <br />
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