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ARCHIVED REPORTS_XR0009194
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_XR0009194
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Entry Properties
Last modified
5/6/2020 11:43:18 AM
Creation date
5/6/2020 11:25:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009194
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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i i <br /> Chain of Custodx Number /3 Y <br /> SECOR Chain-of Custody Record 7 <br /> Field Office 077 Sacramento U 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# 77EL17334 04 Task# 0410 Analysis Request <br /> Protect Manager Jaff Auchtertonle <br /> Laboratory Klff Analytical m m m g m <br /> Tumaround Time Standard a a �,a � <br /> ' o %> 0 - 1 U <br /> Sample's Name Peng Yang o <br /> '� -- q m <br /> m ocmLM m � oom $ <br /> Samplers Signature a E v $ m` m <br /> _ Comments/ <br /> V d d0 d OWNO mN � Q 3 <br /> Sample ID Date Time Matrix x ao > _ v7 0, Instructions z <br /> MW-2 12-1,-6q I!Lv3 Water x X X -d 3 <br /> MW-3 1753io Water x X X 3 <br /> MWS I S Water x X X —a 3 <br /> MW-5A 145b Water x X X "v 3 <br /> MW-5B Jy3b Water x X X ~D 3 <br /> Special Instructions/Comments Relinquished by ,�� Received by Sample Receipt <br /> 5 Oxygenates TAME,MtBE,EtBE,TBA, DIPE Sign -fie yrs Sign Total no of containers <br /> Global ID#T0607700407(SIRC) Print ?1ENk UW 6 Print Chain of custody seals <br /> email EDD to dacatlin@secorcom Company s eca e. Company Recd in good conditionlcold <br /> email results to dherzog@secor corn and Time 1G 3& Date (2--7-0,Y Time Date Conforms to record <br /> tmiller@secor.com Relinquished by Received by <br /> Sign Sign Client SECOR <br /> Print Print / J Client Contact Tom Miller <br /> Compan Company ,�,y�/— 1 q Client Phone (916)861- 00 <br /> Time Date Time /,C;X Date—1-20-70Y ext 279 <br /> i <br /> sEcoa arc a«� � <br /> Date Page <br />
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