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ARCHIVED REPORTS_XR0006779
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_XR0006779
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Entry Properties
Last modified
7/27/2020 3:19:31 PM
Creation date
7/27/2020 2:23:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006779
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 <br /> SECOR Chain-of Custody Record <br /> Field Office 477 Sacramento L3 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# 77EL 21756 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Ktff Analyttcal m _ y �, 2 <br /> Turnaround Time Standard a `� �' °' -- <br /> w C d v 21 <br /> O > 0 _ <br /> Sampler's Name Tom Miller <br /> c� <br /> Sampler's Signature <br /> o o � > o �o m o .50 <br /> p S - o ,� o p m Comments/ <br /> to a o a ° o o04 03 � N Oa <br /> Sample ID Date Time Matrix x m � Q ( z (D to w to LUInstructions z <br /> ✓ MW-1 Y-17-u; //(15- Water X X <br /> MW-2 _0 Water X X <br /> MW-3 y-/7-vS 165 Water X X SF <br /> ✓ MW-4 Y-/7--3 031— Water X X <br /> Special Instructions/Comments Relinquished by :Z:ga- 11;;�' ceived by Sample Receipt <br /> 5 Oxygenates:TAME, MtBE, EtBE,TBA, DIPE Sign Sign Total no of containers <br /> Global 1D#T0607700549(SIRC) Print a�,,i�,irrPrint Chain of custody seals <br /> EDF Deliverables- Email Molly Koch at Company .P �, Camp Rec'd in good condition/cold <br /> mkoch@secor cam Time 15 Date 8 0 e Date Conforms to record <br /> email results to bearey@secor corn inquished by Received by <br /> Sign Sign Client SECOR <br /> Pnnt Print $..; A Client Contact Brian Carey <br /> Comp Company fG A-m,tir,.4i.,.J Client Phone 916 861-0430 <br /> e Date Time ly�_Date P-vZV2 ext. 241 <br /> SECOR CUSTREC Rev Z= <br /> Date i a Page <br />
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