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ARCHIVED REPORTS_XR0006611
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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Y
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YOSEMITE
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1012
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3500 - Local Oversight Program
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PR0545948
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ARCHIVED REPORTS_XR0006611
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Entry Properties
Last modified
9/29/2020 10:18:52 PM
Creation date
8/5/2020 3:57:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006611
RECORD_ID
PR0545948
PE
3528
FACILITY_ID
FA0005159
FACILITY_NAME
FILL-EM FAST
STREET_NUMBER
1012
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
21903024
CURRENT_STATUS
02
SITE_LOCATION
1012 W YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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LSauers
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EHD - Public
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b <br /> SPL HOUSTON ENVIRONMENTAL LABORATORY <br /> SAMPLE LOGIN CHECKLIST <br /> DATE: TIME: CLIENT NO. <br /> IAT NO. CONTRACT NO. <br /> CLIENT SAMPLE NOS. <br /> SPL SAMPLE NOS. : L 0 lJ <br /> 0 <br /> YES N-0 <br /> 1. Is a Chain-of-Custody form present? <br /> 2. Is the COC properly completed? <br /> If no, describe what is incomplete: <br /> I <br /> If no, has the client been contacted about it? <br /> (Attach subsequent documentation from client about the situation) <br /> �• Is airbill/pt/ �tqk—lfg ng �hipment? <br /> If yes, ID# • <br /> Yt V-L-1 I I r4. Is a USEPA Traffic Report present? <br /> 5. Is a USEPA SAS Packing List present? <br /> 6. Are custody seals present on the package? <br /> If yes, were they intact upon receipt? <br /> 7. Are all samples tagged or labeled? <br /> Do the sample tags/labels match the COC? <br /> If no, has the client been contacted about it? <br /> (Attach subsequent documentation from client about the situation) <br /> 8. Do all ' shipping documents agree?' <br /> If no, describer what is in nonconformity: <br /> 9. Condition/temperature of shipping container: <br /> 10. Condition/temperature of sample bottles: <br /> Sample Disposal? : SPL disposal Return t client <br /> NOTES (reference item number if applicable) :- <br /> ATTEST:- <br /> pplicable) :ATTEST: I r' DATE: , <br /> DELIVERED FOR RESOLUTION: REC'D DATE: <br /> RESDLVED: DATE: <br /> I ' <br />
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