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ARCHIVED REPORTS_XR0006772
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_XR0006772
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Entry Properties
Last modified
7/27/2020 3:16:02 PM
Creation date
7/27/2020 2:21:53 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006772
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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Cham of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento E( Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road Suite 100 Job Name 7-Eleven Store#21756 <br /> Rancho Cordova, CA Location 853 East Yosemite Avenue <br /> Manteca, CA <br /> Project# 77E1L.21756 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Kilff Analytical N <br /> Turnaround Time Standard a 2,a, 2 _ 40 Cc <br /> c <br /> w d - 6 o <br /> Sampler's Name Tom M x 0 - o a " ° m o <br /> LU "m_ >3 > (amY _ c7 Qm v <br /> Sampler's Sign e 9 m g N T� 0 o ti N o <br /> EJ = ago rnro } cc m a <br /> a ao x as oN � � � � oa Comments/ <br /> Sample ID Date Time Matrix HCI � 4 � a` >0 � 2 8- �, �, � Instructions z' <br /> MW-1 /3 aY Z136 Water x X X 3 1471 <br /> MW-2 13-°y yr Water x X <br /> X 3 aZ <br /> MWS ` 0 1 Water x X X 3 03 <br /> MW-4 Water x X X 3 C c' <br /> Special Instructions/Comments Relinquished by- Received by Sam le Receipt <br /> 5 Oxygenates TAME, MtBE, EtBE, TBA, DIPE Sign Sign Totaf no of containers <br /> Global ID#T0607700549(SIRC) Print _ PrintChain of custody seals <br /> email EDF to dacatlin @ secor com Company �� Company _ Rec'd in good condition/cold <br /> email lab report to dherzog@seeor com Time Date Ti rn� Date Conforms to record <br /> Relinquished by Received b <br /> Sign Signe Client SECOR <br /> Print Print /)�q x�p/V ,p�r,��2 Client Contact Brian Care <br /> Company Company , Client Phone (916)861-0400 <br /> Ti Date Time ��� S _DateG//$G �/ ext 241 <br /> serba cusmt�c Rw 2M <br /> Date Page <br />
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