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COMPLIANCE INFO_2023
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0547446
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COMPLIANCE INFO_2023
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Entry Properties
Last modified
3/15/2023 3:22:41 PM
Creation date
3/15/2023 3:21:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2023
RECORD_ID
PR0547446
PE
1608
FACILITY_ID
FA0026975
FACILITY_NAME
LOVE AND CONFECTION
STREET_NUMBER
9742
Direction
N
STREET_NAME
SHELTON
STREET_TYPE
RD
City
LINDEN
Zip
95236
CURRENT_STATUS
01
SITE_LOCATION
9742 N SHELTON RD
P_LOCATION
99
QC Status
Approved
Scanner
SJGOV\jcastaneda
Tags
EHD - Public
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FGL Environmental <br />Revision Date: 10/09/14 <br />Doc ID: 3D0900002_SOP_12.DOC <br />Page 1 of 1 <br />Inter- tory Condition Upon Receipt (Attach to COC�.�3e�5 <br />Sample Receipt at: STK CC CH VI <br />1. Number of ice ch packages received: Shipping tracking # <br />2. Were samples received in a chilled condition? Temps: 7. • / / / / <br />Surface water SWTR bact samples: A sample that has a temperature upon receipt of >I00 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 <br />N/A <br />4. Were samples received intact? (i.e. no broken bottles, leaks etc.) Yes <br />No <br />5. VOAs checked for Headspace? Yes <br />No <br />6. Were sample custody seals intact? Yes <br />No <br />7. If required, was sample split for pH analysis? yjeA <br />No <br />8. Were all analyses within holding times at time of receipt? CQ= <br />No <br />9. Verify sample date, time and sampler name Yes <br />No <br />Sign and date the COC, place in a ziplock and put in the ice chest as the 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 packages are received at one time check for iests/H.T.'s/mshesi <br />2. Shipping tracking numbers: <br />3. Do the number of bottles received agree with the COC?a <br />No <br />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 />/A <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? e <br />No <br />�FGL <br />(Exception: Oil & Grease, VOA and CM verified in labl <br />4. VOAs checked for Headspace? Yes <br />No <br />5. Have rush or project due dates been checked and accepted? YNo <br />6. Were all analyses within holding times at time of receipt? es <br />No <br />Attach labels to the containers and include a copy of the COC for lab eliv <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: <br />Initiated By: <br />Problem: <br />Resolution: <br />(Please use the back of this sheet for additional comments or <br />contacts) <br />Phone Number: <br />Date: <br />Attach label with lab number here <br />
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