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COMPLIANCE INFO_2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0543757
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
12/3/2020 7:47:31 AM
Creation date
11/17/2020 7:56:45 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0543757
PE
1609
FACILITY_ID
FA0024873
FACILITY_NAME
RED HEN PRESERVES
STREET_NUMBER
17572
STREET_NAME
MELLO
STREET_TYPE
RD
City
RIPON
Zip
95366
CURRENT_STATUS
01
SITE_LOCATION
17572 MELLO RD
P_LOCATION
05
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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i <br /> FGL Environmental Doc ID:3D0900002_SOP_12-3.DOC <br /> Revision Date: 10/09/14 Page 1 of 1 <br /> InterVory Condition Upon Receipt (Attach to COC) �5/f <br /> Sample Receipt at: STK CC CH VI <br /> 1. Number of ice c packages received: _LShipping tracking# <br /> 2. Were samples received in a chilled condition? Temps:�/ <br /> Surface water SWTR batt samples:A sample that has a temperature upon receipt of >I0°C,whether iced or not, <br /> should be flagged unless the time since sample collection has been less than two hours. <br /> 3. Do the number of bottles received agree with the COC? No N/A <br /> 4. Were samples received intact?(i.e. no broken bottles, leaks et No <br /> 5. VOAs checked for Headspace? Yes No <br /> 6. Were sample custody seals intact? Yes N <br /> 7. If required, was sample split for pH analysis? N <br /> 8. Were all analyses within holding times at time of receipt? es o <br /> 9. Verify sample date, time and sampler name No <br /> Sign and date the COC,place in a ziplock and put i e i ch pies. <br /> Sample Receipt Review completed by(initials): <br /> Sample Receipt at SP: l <br /> 1. Were samples received in a chilled condition? Temps: <br /> Acceptable is above freezing to 61PC. If man packages are revived o9e time check testsM.T s/mshest /� <br /> 2. Shipping tracking numbers: 1 /' // Afor �7 <br /> 3. Do then ero ecetyd agree with the C C? e No N/A <br /> 4. Were samples received intact? (i.e. no broken bottles, leaks etc.) Yes No <br /> 5. Were sample custody seals intact? Yes No CRD <br /> Sign and date the COC,obtain LIMS sample numbers,select methods/tests and print labels. <br /> Sample Verification,Labeling and Distribution: <br /> 1. Were all requested analyses understood and acceptable? No <br /> 2. Did bottle labels correspond with the client's ID's? es No <br /> 3. Were all bottles requiring sample preservation properly preserved? Yes No (—rfVA> FGL <br /> [Exception:Oil&Grease,VOA and CrVI verified in labl <br /> 4. VOAs checked for Headspace? Yes NoN/A <br /> 5. Have tush or project due dates been checked and accepted? Yes No N/A <br /> 6. Were all analyses within holding times at time of receipt? Yes No <br /> Attach labels to the containers and include a copy of the CO a [very. <br /> Sample Receipt, Login and Verification completed by (initia� <br /> Discrepancy Documentation: <br /> Any items above which are"No"or do not meet specifications (i.e. temps)must be resolved. <br /> I. Person Contacted: Phone Number: <br /> Initiated By: Date: <br /> Problem: <br /> Resolution: <br /> 2. Person Contacted: Phone Numbpr- <br /> Initiated By: (3018570) <br /> Resolution: Carol FCallil8 <br /> (Please use the back of this sheet for additional com STK2054267 <br /> contacts) app 1010012020 12:52:24 <br />
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