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** PLEASE CHECK LOOKUP - if good, then Approve QCStatus, else update with correct RECORD_ID
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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TSIRELAS
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23273
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4200/4300 - Liquid Waste/Water Well Permits
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PR0543204
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** PLEASE CHECK LOOKUP - if good, then Approve QCStatus, else update with correct RECORD_ID
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Entry Properties
Last modified
3/2/2026 11:51:22 AM
Creation date
5/1/2024 2:27:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
PR0543204
PE
4233 - ALT/ENG OWTS - ANNUAL PERMIT - Sampling Only
FACILITY_ID
FA0024628
FACILITY_NAME
MONJES, TESSY
STREET_NUMBER
23273
Direction
S
STREET_NAME
TSIRELAS
STREET_TYPE
DR
City
TRACY
Zip
95304
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
23273 S TSIRELAS DR TRACY 95304
Tags
EHD - Public
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FGL Environmental Doc ID: 3DO900002 SOP 14.DOC <br /> Revision Date: 10/10/23 Page 1 of 1 <br /> Inter-Laboratory Cond' icon on Receipt (Attach to COQ�l-k3�at-i <br /> Sample Receipt at: CC CH VI <br /> 1. Number of ice chests/packages received: Shipping tracking#(s): <br /> 2. Temp IR Gun ID #tom <br /> 3. Were samples received on ice? Q� No Temps <br /> Surface water SWTR bact samples: A sample that has a temperature upon receipt of >10'C,whether iced or not, <br /> should be flagged unless the time since sample collection has been less than two hou <br /> 4. Do the number of bottles received agree with the COC? No N/A <br /> 5. Were samples received intact? (i.e. no broken bottles, leaks etc.) No <br /> 6. VOAs checked for Headspace? Yes No <br /> 7. Were all analyses within holding times at time of receipt? qe.�� <br /> No <br /> 8. Verify sample date, time and sampler name No <br /> Sign and date the COC, place in a ziplock and put in t same ice chest as the samples. <br /> Sample Receipt Review completed by (initials): <br /> 0111/ <br /> Sample Receipt at SP: <br /> 1. Number of ice chests/packages received: Shipping tracking #(s): <br /> 2. Temp IR Gun ID #: I S12�r'3 <br /> 3. Were samples received on ice? es No Temps:�Q/ <br /> Acceptable is above freezing to 6°C. If packages are received at one time check for tests/H.T.'s/rushes/ <br /> 4. Do the number of bottles received agree with the COC? No N/A <br /> 5. Were samples received intact? (i.e. no broken bottles, leaks etc.) a 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? No <br /> 2. Did bottle labels correspond with the client's ID's? t No <br /> 3. Were all bottles requiring sample preservation properly preserved? Yes No FGL <br /> [Exception:Oil&Grease,VOA and CrVt verified in labl <br /> 4. VOAs checked for Headspace? Yes No <br /> 5. Have rush or project due dates been checked and accepted? Y No / <br /> 6. Were all analyses within holding times at time of receipt? e No <br /> Attach labels to the containers and include a copy of the COC for lab deli ry. <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: (3017919) <br /> Initiated By: San Joaquin County EHD <br /> Problem: <br /> Resolution: STK2434244 <br /> iv 031j29``,lIII2II0ii��I2llll4,,1lII0������9��36 <br /> (Please use the back of this sheet for additional comments or N11�Ufl�lA111 11 <br />
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