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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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PR0546753
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
5/11/2022 4:15:16 PM
Creation date
5/11/2021 2:14:36 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0546753
PE
1608
FACILITY_ID
FA0026501
FACILITY_NAME
ELLIOTT ROAD BARN
STREET_NUMBER
23216
Direction
N
STREET_NAME
ELLIOTT
STREET_TYPE
RD
City
ACAMPO
Zip
95220
CURRENT_STATUS
01
SITE_LOCATION
23216 N ELLIOTT RD
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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FGL Environmental Doe IGD:3DO900002_SOP_12.DOC <br /> Revision Date: 10/09/14 Page I of I <br /> Inter- tory Condition Upon Receipt (Attach to COC) 7i13�� <br /> Sample Receipt at' STK C CH VI <br /> 1. Number of i es received: ' Shipping tracking N <br /> 2. Were samples received in a chilled condition? Temps: ) f <br /> Surface water SWPR batt samples:A sample that has a temperature upon receipt of>loo 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 es• No <br /> 5. VOAs checked for Headspace? es o <br /> 6. Were sample custody seals intact? Yes 1 <br /> 7. If required,was sample split for pH analysis? Yes <br /> 8. Were all analyseswithin holding times at time of receipt? <br /> 9. Verify sampmplee date,time and sampler namea No <br /> Sign and date the COC,place in a ziplock and put i the same ice c 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 60 C. If many acknges arc received at Inc time check for tests/H.T.'s1rushes/ <br /> ng num ers: <br /> too <br /> 3. Do the number of bottles received agree with the COC? es . No N/A <br /> 4. Were samples received intact?(i.e.no broken bottles, leaks etc.) es No <br /> 5. Were sample custody seals intact? es No ep <br /> Sign and date the COC,obtain LIMS sample numbers,select methods/tests and print labels. <br /> Sample Verification,Labeling and Distribution: <br /> I. Were all requested analyses understood and acceptable? Ves <br /> No <br /> 2. Did bottle labels correspond with the client's ID's? No <br /> 3. Were all bottles requiring sample preservation properly preserved? No 0) FGL <br /> lExcepllon:Oil&Grense.VOA and Crvl verified In tnbl <br /> 4. VOAs checked for Headspace? Yes No <br /> 5. Have rush or project due dates been checked and accepted? Yes No N r� <br /> 6. Were all analyses within holding times at time of receipt? No <br /> Attach labels to the containers and include a copy of the COC for lab delivery. ^ <br /> Sample Receipt,Login and Verification completed by(initials): �J <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: Dale: <br /> Problem: <br /> Resolution: <br /> 2. Person Contacted: (3018723) + <br /> Initiated By: Julie Edsell <br /> Problem: STONE <br /> er here <br /> (Please use the back of this sheet for addil apb 0311112021 16p:19:301I0��IIhI��III�In�JI� <br /> contacts) <br />
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