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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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PR0161195
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
12/20/2021 4:26:32 PM
Creation date
6/15/2021 8:42:55 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0161195
PE
1615
FACILITY_ID
FA0000083
FACILITY_NAME
STOP & SHOP MART
STREET_NUMBER
255
Direction
E
STREET_NAME
FRENCH CAMP
STREET_TYPE
RD
City
FRENCH CAMP
Zip
95231
APN
19310014
CURRENT_STATUS
01
SITE_LOCATION
255 E FRENCH CAMP RD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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SJGOV\jcastaneda
Tags
EHD - Public
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FGL Enviromn mental Doc ID:3DO900002_SOP_12-2.DOC <br /> Revision Date: 10/09/14 Page 1 of 1 <br /> Inter-dory Condition Upon Receipt (Attach to COC)41,52&6 <br /> Sample Rece pt at: ST CC CH VI <br /> 1. Number of ice chests/packages received: Shipping tracking# <br /> 2. Were s pies received in a chilled condition? Temps: <br /> Surface w ter S WTR bact samples: A sample that has a temperature upon receipt of >10°C,whether iced or not, <br /> should be flagge unless the time since sample collection has been less than two hours. <br /> 3. Do the n ber of bottles received agree with the COC? E�No N/A <br /> 4. Were s ples received intact? (i.e. no broken bottles, leaks etc.) o <br /> 5. VOAs cl ecked for Headspace? Yes No <br /> 6. Were sat iple custody seals intact? Yes No <br /> 7. If requir d, was sample split for pH analysis? Yes No <br /> 8. Were all analyses within holding times at time of receipt? No <br /> 9. Verify si mple date,time and sampler name No <br /> Sign and date he COC, place in a ziplock and put in a ice chest as the samples. <br /> Sample Recei t Review completed by (initials): <br /> Sample Recei tat SP: <br /> I. Were ples received in a chilled condition? Temps: �/ <br /> Acceptabl is above freezing to 68 C. If many packages are received at one time check for tests/H.T.'s/rushes/ <br /> 2. Shipping tracking numbers: ,�,�31 ) <br /> 3. Do the n ber of bottles received agree with the COC? J es No N/A <br /> 4. Were pies received intact? (i.e. no broken bottles, leaks etc.) es No <br /> 5. Were san ple custody seals intact? Yes No (SA2 <br /> Sign and date t ie COC, obtain LIMS sample numbers, select methods/tests and print labels. <br /> Sample Verification, Labeling and Distribution: <br /> 1. Were all i equested analyses understood and acceptable? � No <br /> 2. Did bottl labels correspond with the client's ID's? No <br /> 3. Were all ottles requiring sample preservation properly preserved? Yes No FGL <br /> ]Exception:Oil&Grease,VOA and CM verified in lab] <br /> 4. VOAs chcked for Headspace? Yes No <br /> 5. Have rus or project due dates been checked and accepted? Yes No <br /> 6. Were all yses within holding times at time of receipt? No <br /> Attach labels t the containers and include a copy of the COC for lab delivery. <br /> Sample Receip Login and Verification completed by(initials):� � <br /> Discrepancy D cumentation: <br /> Any items abo which are "No" or do not meet specifications(i.e. temps)must be resolved. <br /> 1. Person C tacted: Phone Number: <br /> Initiated y: Date: <br /> Problem: <br /> Resolutio <br /> 2. Person Co tacted: Phnno T`T—'- <br /> Initiated (3018813) <br /> Problem: Beanie Grocery <br /> Resolutio STK2138315 <br /> (Please use the ack of this sheet for addition( ere <br /> contacts) apt,0@@611412021 16:15:05 <br />
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