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ARCHIVED REPORTS_XR0006766
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0508124
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ARCHIVED REPORTS_XR0006766
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Entry Properties
Last modified
7/27/2020 3:21:07 PM
Creation date
7/27/2020 2:20:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006766
RECORD_ID
PR0508124
PE
2950
FACILITY_ID
FA0007949
FACILITY_NAME
7 ELEVEN #21756
STREET_NUMBER
853
Direction
E
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
22332015
CURRENT_STATUS
01
SITE_LOCATION
853 E YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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• Chain of Custody Number L <br /> SECOR Chain-of Custody Record <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 921756 <br /> Rancho Cordova,CA Location 853 East Yosemite Avenue <br /> Manteca,CA <br /> Project# 77EL.21756 05 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie o <br /> Laboratory Kfff Analytical W m <br /> Turnaround rime Standard - d i. _ <br /> o� <br /> Sampler's Name 40 m <br /> Sampler's Signature °E m R N m ¢ <br /> x =W = W a $i i E I a Commental E <br /> Sample ID Date Time Matrix HCI � � m _ 2 a Instructions i <br /> MW-1 -o /6j16 Water x X X 3 <br /> MW-2 +i3 Water x X X -0:11L 3 <br /> MW-3 0?ib Water x X X -03 3 <br /> MWS Q&2 Water x X X 3 <br /> _ 1 <br /> Ogc? <br /> S� C**w www"N <br /> Special Instructions/Comments Rellnqumhed by Received by Sample Receipt <br /> 5 Oxygenates:TAME,MtBE,EtBE,TBA, DIPE Sign Sign Total no of containem <br /> Global ID#70507700549(SIRC) Print Print Chain of custody seals <br /> email EDF to cryan@secor.com Company .— Compan Recd in good condition/cold <br /> email fab report to dhersog@secor corn and Time Date -a a Date Conforms to record <br /> dbrown@secor com Relinquished by Recenred b <br /> Sign Sign Client SECOR <br /> Print Pnnt Client Contact <br /> q9ppscy Company Client Phone (916)8514)400 <br /> -SECOR -,-,rime Date Time :jS Date aQ Ig <br /> arc w.�.. <br /> Date S-I,b-erPage <br />
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