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WP0040996 (2)
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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WP0040996 (2)
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Entry Properties
Last modified
8/19/2026 8:47:20 AM
Creation date
4/30/2026 11:52:18 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
File Section
COMPLIANCE INFO
RECORD_ID
WP0040996
PE
4366 - WELL DOMESTIC - </= 2 ACRE FT/YEAR
STREET_NUMBER
23403
Direction
S
STREET_NAME
HANSEN
STREET_TYPE
RD
City
TRACY
Zip
95304-
APN
20939028
CURRENT_STATUS
Closed
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
23403 S HANSEN RD TRACY 95304-
Tags
EHD - Public
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i <br /> FGL Environmental Doc ID:3DO900002_SOP_14.doc <br /> Revision Date: 10/10/23 i Page 1 of 1 • <br /> Inter-Laboratory Condit' pon Receipt ( tt�ch to COQ <br /> Sample Receipt at: CC CH 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? (Yes o Temps: <br /> Surface water SWTR bact samples:A sample that has a temperature upon receipt of >100 C,whether iced or not, <br /> should be flagged unless the time since sample collection has been less than Iwo 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.) Ye No <br /> 6. VOAs checked for Headspace? Ye No GD <br /> 7. Were all analyses within holding times at time of receipt? 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 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: Shipping tracking#(s): SCE 1 <br /> 2. Temp IR Gun ID#: ZOR <br /> 3. Were samples received on ice? (5Ye No Temps: <br /> Acceptable is above freezing to 6°C. If many packages are received at one time oheck for tests/H.T.'s/rushes/ <br /> 4. Do the number of bottles received agree with the COC? es No N/A <br /> 5. Were samples received intact? (i.e. no broken bottles, leaks etc.) s No <br /> Sign and date the COC, obtain LIMS sample numbers, select methods/test and print labels. <br /> Sample Verification, Labeling and Distribution: <br /> 1. Were all requested analyses understood and acceptable? s No <br /> 2. Did bottle labels correspond with the client's ID's? No <br /> 3. Were all bottles requiring sample preservation properly preserved? es No N/A FGL <br /> [Exception: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 <br /> 6. Were all analyses within holding times at time of receipt? Ces No <br /> Attach labels to the containers and include a copy of the COC for ab deli ery. <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: i <br /> Problem: <br /> Resolution: <br /> 2. Person Contacted: Phone Ntber: <br /> Initiated By: __Date• <br /> � i Problem: (301 7919,, <br /> 1 <br /> Resolution: San J a uin CounWNO <br /> q <br /> (Please use the back of this sheet for additional comments c Sll�� 6511'108 <br /> mds�l0712912 1 8:01 <br /> [ll[ll[lfll�lll[Illlll[ll[[I[f[Illl[!I <br /> STK2651208 <br />
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