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COMPLIANCE INFO_2021
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0541527
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
3/9/2021 3:09:25 PM
Creation date
3/9/2021 3:06:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0541527
PE
1608
FACILITY_ID
FA0023807
FACILITY_NAME
SMIT FARMS
STREET_NUMBER
12253
STREET_NAME
CLEMENTS
STREET_TYPE
RD
City
LINDEN
Zip
95236
CURRENT_STATUS
01
SITE_LOCATION
12253 CLEMENTS RD
P_LOCATION
99
QC Status
Approved
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SJGOV\jcastaneda
Tags
EHD - Public
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FGL Environmental Doc 11r: ADn00000z sop r,_tz.Doc 7 <br /> Revision Date: 10/09/14 Page I of 1 (( <br /> Inter-Dory Condition Upon Receipt (Attach to COC) 01QJ�aC�� <br /> Sample Receipt at: TK CC CH VI <br /> 1. Number of ice c ackages received: _LShipping tracking# <br /> 2. Were samples received in a chilled condition? Temps: IO•71 <br /> Surface water S WTR bact 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 etc. es No <br /> 5. VOAs checked for Headspace? Yes No <br /> 6. Were sample custody seals intact? Yes No <br /> 7. if required, was sample split for pH analysis? Yes No <br /> 8. Were all analyses within holding times at time of receipt? No <br /> 9. Verify sample date,time and sampler name No <br /> Sign and date the COC,place in a ziplock and put in the same icechest a e samples. <br /> Sample Receipt Review completed by(initials): <br /> Sample Receipt at SP: <br /> 1. Were samples received in a chilled condition? Temps: <br /> Acceptable is above freezing to 6&C. Ifmmy packages ere received at one time ch_eck for testsM.T'shushes/ <br /> 2. Shipping tracking numbers: <br /> 3. Do the number of bv � <br /> bottles received agreeIc � ( <br /> 4. Were samples received intact?(i.e.no broken bottles, leaks etc.) es Noo N/A <br /> 5. Were sample custody seals intact? Yes No N/ <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? Ques, 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 NoFGL <br /> [Exception:Oil&Grease,VOA and CrVt verified in labl <br /> 4. VOAs checked for Headspace? Yes No <br /> 5. Have rush or project due dates been checked and accepted? Yes No AA <br /> 6. Were all analyses within holding times at time of receipt? es No <br /> Attach labels to the containers and include a copy of the COC for lab deliver <br /> Sample Receipt, Login and Verification completed by(initials)' <br /> Discrepancy Documentation: <br /> Any items above which are"No"or do not meet specifications(i.e. temps)must be resolved. <br /> 1. Person Contacted: Phone Number: <br /> Initiated By: Date: <br /> Problem: <br /> Resolution: <br /> 2. Person Contacted: Phone Number: <br /> Initiated By: _ <br /> ! J-144071 <br /> Problem: <br /> Resolution: �•• • - -". <br /> (Please use the back of this sheet for additional comment <br /> contacts) <br />
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