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WP2400098 (2)
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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F
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4 (STATE ROUTE 4)
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30444
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4200/4300 - Liquid Waste/Water Well Permits
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WP2400098 (2)
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Entry Properties
Last modified
6/4/2026 9:03:58 AM
Creation date
5/28/2026 3:32:30 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
File Section
COMPLIANCE INFO
RECORD_ID
WP2400098
PE
4370 - WELL REPLACEMENT-Existing Well Not Viable
STREET_NUMBER
30444
Direction
E
STREET_NAME
STATE ROUTE 4
City
FARMINGTON
Zip
95230
APN
18744007
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
30444 E STATE ROUTE 4 FARMINGTON 95230
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"4n pon Receipt (Attach to COQ�(J(JVN <br /> Sample Receipt at: CC CH 11� 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? es No Temps: <br /> Surface water SWTR bact samples: A sa that has a temperature upon receipt of 71 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.) Ye No <br /> 6. VOAs checked for Headspace? Ye No kN/A <br /> 7. Were all analyses within holding times at time of receipt? No <br /> 8. Verify sample date,time and sampler name No <br /> Sign and date the COC, place in a ziplock and put in th s e 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): S6gLILI176o <br /> G <br /> 2. Temp IR Gun ID #: 7I1G <br /> 3. Were samples received on ice? LYee No Temps: <br /> Acceptable is above freezing to 6°C. 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? Ord No N/A <br /> 5. Were samples received intact? (i.e. no broken bottles, leaks etc.) es . No <br /> Sign and date the COC, obtain LIMS sample numbers, select methods/tests 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? No <br /> 3. Were all bottles requiring sample preservation properly preserved? Yes No N/A FGL <br /> (Exception:Oil&Grease,VOA and CM 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 N/A <br /> 6. Were all analyses within holding times at time of receipt? Ye No <br /> Attach labels to the containers and include a copy of the COC for lab delivery. <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: - <br /> Problem: (3017919) <br /> Resolution: San Joaquin County IN <br /> ST037321 <br /> (Please use the back of this sheet for additional comments or c iv 05/2012026 07:35:19 <br /> III IIIIIIIIIIIIIIIIIIIIIIIII <br />
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