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WP0042135
EnvironmentalHealth
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12 (STATE ROUTE 12)
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10943
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4300 - Water Well Program
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WP0042135
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Entry Properties
Last modified
12/4/2024 9:17:54 AM
Creation date
8/1/2022 1:32:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4300 - Water Well Program
RECORD_ID
WP0042135
PE
4366 - WELL DOMESTIC - </= 2 ACRE FT/YEAR
STREET_NUMBER
10943
Direction
E
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240-
APN
05115049
CURRENT_STATUS
Inactive
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
10943 E STATE ROUTE 12 LODI 95240-
Tags
EHD - Public
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FGL Environmental Doc ID:3DO900002_SOP_12.DOC <br /> Revision Date: 10/09/14 Page 1 of 1 <br /> Inter- o atory Condition Upon Receipt (Attach to COC) <br /> Sample Receipt a . TK CC CH VI <br /> 1. Number of is c ages received: Shipping tracking# <br /> 2. Were samples received in a chilled condition? Temps:IUl <br /> Surface water SWTR bact samples: A sample that has a temperature upon receipt of X10°C,whether iced or not, <br /> should be flagged unless the time since sample collection has been less than two hour <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 o <br /> 5. VOAs checked for Headspace? iesampples. <br /> N <br /> 6. Were sample custody seals intact? N <br /> 7. If required, was sample split for pH analysis? <br /> 8. Were all analyses within holding times at time of receipt? <br /> 9. Verify sample date,time and sampler name No <br /> Sign and date the COC,place in a ziplock and put in the a ice c <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 packages are received at one time check for tests/H.T.'s/rushes/ <br /> 2. Shipping tracking numbers: <br /> V <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.) kesNo <br /> 5. Were sample custody seals intact? Yes 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? ge <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? Ya. No N/A FGL <br /> ]Exception:Oil&Grease,VOA and CM verified in lab] <br /> 4. VOAs checked for Headspace? Yes No /A <br /> 5. Have rush or project due dates been checked and accepted? Yes No <br /> 6. Were all analyses within holding times at time of receipt? 9e 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): <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 /> (3017919) <br /> 2. Person Contacted: San Joaquin ERB <br /> Initiated By: <br /> Problem: STK2239886 <br /> Resolution: iv 0711412022 07:30:13 <br /> }11111111�1��1�111�11�11111111 <br /> ( <br /> Please use the back of this sheet for additional con <br /> STS._11111 ,236gN <br /> contacts) <br />
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