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AP2502053
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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AP2502053
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Entry Properties
Last modified
4/2/2026 11:52:44 AM
Creation date
10/16/2025 2:57:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
AP2502053
PE
4366 - WELL DOMESTIC - </= 2 ACRE FT/YEAR
STREET_NUMBER
1094
Direction
W
STREET_NAME
LUCAS
STREET_TYPE
RD
City
LODI
APN
01504060
CURRENT_STATUS
Closed - Issued
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
1094 W LUCAS RD LODI
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 Condit' Upon Receipt (Attach to COQW 6051F5 <br /> Sample Receipt at: CC CH TK VI <br /> 1. Number of ice chests/packages received: / Shipping tracking#(s): <br /> 2. Temp IR Gun ID #:TH319 <br /> 3. Were samples received on ice? 0 No Temps: <br /> Surface water SWTR bact samples: A sample that has a temperature upon receipt of >i 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.) No <br /> 6. VOAs checked for Headspace? INo N/A <br /> 7. Were all analyses within holding times at time of receipt? - No <br /> 8. Verify sample date, time and sampler name Ye No <br /> Sign and date the COC, place in a ziplock and put in th ame ice chest as the samples. <br /> Sample Receipt Review completed by (initials): <br /> Sample Receipt at SP: <br /> 1. Number of ice chests/packages received: 7i Shipping tracking #(s): r7(��1Z3 73�t '► <br /> 2. Temp IR Gun ID #:�� 5q <br /> 3. Were samples received on i'ce? es No Temps: - / / <br /> Acceptable is above freezing to 6T. if m y packages are received atone 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.) 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? ffe No <br /> 3. Were all bottles requiring sample preservation properly preserved? Yes No N/ FGL <br /> [Exception:Oil&Grease,VOA and CM verified in lab] <br /> 4. VOAs checked for Headspace? ems/ No N/A <br /> 5. Have rush or project due dates been checked and accepted? Yes No N/ <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 del <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: Phone Number: <br /> Initiated By: Date-- <br /> Problem: (3017919) <br /> Resolution: San Juyin County EHD <br /> (Please use the back of this sheet for additional comments or cc STUHH95 <br /> iv 0312612026 07:59:08 <br /> III IIIIVIIIIIIIIIIIIIIIIIII <br />
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