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COMPLIANCE INFO_2022
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KENNEFICK
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1600 - Food Program
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PR0547668
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
6/9/2022 4:54:53 PM
Creation date
6/9/2022 4:53:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0547668
PE
1608
FACILITY_ID
FA0027138
FACILITY_NAME
MAMA'S TOUCH SPECIALTY COOKIES
STREET_NUMBER
21600
Direction
N
STREET_NAME
KENNEFICK
STREET_TYPE
RD
City
ACAMPO
Zip
95220
CURRENT_STATUS
01
SITE_LOCATION
21600 N KENNEFICK RD
QC Status
Approved
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SJGOV\jcastaneda
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EHD - Public
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FGL Environmental <br />Revision Date: 10/09/14 <br />Doc ID: 3D0900002_SOP_12-1.DOC <br />Page 1 of 1 <br />Inter- tory Condition Upon Receipt (Attach to COC) O 3�17V <br />Sample Receipt at: STK CC CH VI <br />1. Number of ice to <br />received:�Shippin pitracking # <br />2. Were samples received in a chilled condition? Temps: / r / <br />Surface water SWTR bact samples: A sample that has a temperature upon receipt of ; IOa 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 a Ye No <br />5. VOAs checked for Headspace? Yes <br />6. Were sample custody seals intact? Yes I� <br />7. If required, was sample split for pH analysis? <br />8. Were all analyses within holding times at time of receipt? No <br />9. Verify sample date, time and sampler name a No <br />Sign and date the COC, place in a aiplock and put in the same ice ches pies. <br />Sample Receipt Review completed by (initials):_J <br />Sample Receipt at SP: <br />I. Were samples received in a chilled condition? Temps: 3 / 3 / 3 -/—/— <br />Acceptable <br />/Acceptable is above freezing to 60 C. If many packages are received at one time check for testsM.T.'s/rushes/ <br />2. Shipping tracking numbers: 1 I2&AW / %R072415-14 <br />3. Do the number of bottles received agree with the COC? <br />No N/A <br />4. Were samples received intact? (i.e. no broken bottles, leaks etc.) <br />No <br />5. Were sample custody seals intact? Yes <br />No <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? <br />No <br />2. Did bottle labels correspond with the client's ID's? <br />No <br />3. Were all bottles requiring sample preservation properly preserved?es <br />No N/A FGL <br />IExceptlon: Oil & Grease, VOA and CrVI verified In labl <br />4. VOAs checked for Headspace? Yes <br />No <br />5. Have rush or project due dates been checked and accepted? Yes <br />No ctVA <br />6. Were all analyses within holding times at time of receipt? v'-JI11— <br />No <br />Attach labels to the containers and include a copy of the COC for ]ab delivery. <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 />I. Person Contacted: Phone Number: <br />Initiated By: <br />Problem: <br />Resolution: <br />2. Person Contacted: <br />Initiated By: <br />Problem: <br />Resolution: <br />(Please use the back of this sheet for adt <br />contacts) <br />(3019150) <br />Mike Wuhke <br />STC233190 <br />iv 0310912022 0u7:I27:48 <br />�I�II� ulul�ul�II�9I�fI�W <br />bei here <br />
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