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AP2502315
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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4200/4300 - Liquid Waste/Water Well Permits
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AP2502315
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Entry Properties
Last modified
2/3/2026 8:42:55 AM
Creation date
7/28/2025 10:39:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
AP2502315
PE
4366 - WELL DOMESTIC - </= 2 ACRE FT/YEAR
STREET_NUMBER
15124
Direction
S
STREET_NAME
JELLYBEAN
STREET_TYPE
LN
City
OAKDALE
Zip
95361
APN
22913074
CURRENT_STATUS
Closed - Issued
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
15124 S JELLYBEAN LN OAKDALE 95361
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 ConditZpon Receipt (Attach to COQ Ao30�S <br /> Sample Receipt at: CC CH gSf VI <br /> 1. Number of ice chests/packages received: 1 Shipping tracking#(s): <br /> 2. Temp IR Gun ID #:TH319 <br /> 3. Were samples received on ice? 65� 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 hours. <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.) es No <br /> 6. VOAs checked for Headspace? Yes No V/1� <br /> 7. Were all analyses within holding times at time of receipt? es No <br /> 8. Verify sample date,time and sampler name (Yes-) No <br /> Sign and date the COC,place in a ziplock and put in the same ice chest as birsamples. <br /> Sample Receipt Review completed by (initials): <br /> Sample Receipt at SP: <br /> 1. Number of ice chests/packages received: 3 Shipping tracking#(s): 563g?� 3 S 6 <br /> 2. Temp IR Gun ID #: � 1(1 ,�,� <br /> y-7 syy <br /> 3. Were samples received on is � No Temps: _ / / / / <br /> Acceptable is above freezing to 6T. If many 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.) 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? No <br /> 2. Did bottle labels correspond with the client's ID's? Y No <br /> 3. Were all bottles requiring sample preservation properly preserved. es No N/A FGL <br /> lException:Oil&Grease,VOA and CM verified in lab[ <br /> 4. VOAs checked for Headspace? Yes No <br /> 5. Have rush or project due dates been checked and accepted? Yes No e/A <br /> 6. Were all analyses within holding times at time of receipt? Yes No <br /> Attach labels to the containers and include a copy of the COC for lab delivw. <br /> Sample Receipt, Login and Verification completed by (initials): r�l <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: Phone Number: <br /> Initiated By: r» <br /> Problem: (3017919) <br /> Resolution: San JoaquinCounfy M <br /> (Please use the back of this sheet for additional comments or con STK253�257iV8 <br /> IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIII <br /> T� <br />
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