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ARCHIVED REPORTS_XR0009189
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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P
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PERSHING
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4501
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3500 - Local Oversight Program
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PR0545651
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ARCHIVED REPORTS_XR0009189
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Entry Properties
Last modified
5/6/2020 11:42:26 AM
Creation date
5/6/2020 11:23:32 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009189
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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EHD - Public
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Chain of Custody Number ` <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento L3 Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#17334 <br /> Rancho Cordova,CA Location 4501 North Pershing Avenue <br /> Stockton,CA <br /> Project# 77EL.17334 05 Task# 0410 alysis Request <br /> Project Manager Damon Brown <br /> Laboratory KW Analytical g m <br /> Tumaround Time Standard <br /> �0 > o� a <br /> Samplers Name <br /> W C i e,0 a o L).� rt � <br /> Samplers Signature :° °E a m N o N �, <br /> g x = ' s e a 2 0 li< Comments/ E <br /> Sample ID ate Time Matrix F $ > m z S W Instructions z' <br /> MW-2 i NA3 Water x x x 3 -01 <br /> MW-3 I Rif Water x X X 3 -vZ <br /> MW-4 <<pZ Water x X X 3 <br /> MW-5A Water x X X 3 <br /> MW-513 4 Q1N Water x X x 3 <br /> Special Instructions/Comments Relinqui N Received by Sample Receipt <br /> 5 Oxygenates-TAME,MtBE,EtBE,TBA,DIPE Sign Sign Total no of containers <br /> Global ID#70607700407(SIRC) Print Pnnt Chain of custody seals <br /> email EDD to cryan@secor.com Company Compan Recd in good oondibonhwid <br /> email results to dhertog@secor com and Time &-Date Ti Date Conforms to record <br /> dbroown@secor.com Relinquished by Received b <br /> Sign Sign Client: SECOR <br /> Ten+p Them.O� Print Print Client Contact Damon Brown <br /> l Com Company C d Client Phone (916)861-0400 <br /> D D I Z - -- «{ a Date Time I (d Dato ext.330 <br /> Coohnt resent. 1 Mo <br /> d <br /> Date Page r <br />
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