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SR0065527 (2)
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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SR0065527 (2)
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Entry Properties
Last modified
6/4/2026 9:02:44 AM
Creation date
5/28/2026 3:32:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
File Section
COMPLIANCE INFO
RECORD_ID
SR0065527
PE
4370 - WELL REPLACEMENT-Existing Well Not Viable
STREET_NUMBER
17947
Direction
S
STREET_NAME
SEIDNER
STREET_TYPE
AVE
City
ESCALON
Zip
95320
APN
22925047
CURRENT_STATUS
Active, billable
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
17947 S SEIDNER AVE ESCALON 95320
Tags
EHD - Public
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FGL Environmental Doc ID: 3D0900002_SOP_14.doc <br /> Revision Date: 10/10/23 Page 1 of 1 <br /> Inter-Laboratory Conditio Upon Receipt (Attach to COQ�7, -( <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 No Temps: L <br /> Surface water SWTR bact samples: A sample that has a temperature upon receipt of >l0°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? a <br /> 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 /A <br /> 7. Were all analyses within holding times at time of receipt? & No <br /> 8. Verify sample date, time and sampler name a No <br /> Sign and date the COC, place in a ziplock and put 'n he same ice chest as samples. <br /> Sample Receipt Review completed by (initials): a <br /> Sample Receipt at SP: SG y��/��6D <br /> 1. Number of ice chests/packages received: � Shipping tracking#(s): <br /> � t�L�CI 1S3FS <br /> 2. Temp IR Gun ID #: VJZt, (-O <br /> 3. Were samples received on ice? Yes No Temps: <br /> Acceptable is above freezing to 6°C. If on y 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? ds <br /> 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? No <br /> 3. Were all bottles requiring sample preservation properly preserved? t No N/A FGL <br /> [Exception:Oil&Grease,VOA and CrVI verified in labl <br /> 4. VOAs checked for Headspace? Yes No <br /> 5. Have rush or project due dates been checked and accepted? Yes No eN/ <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 delivery. <br /> Sample Receipt, Login and Verification completed by (initials): LA-_x - <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 EHD <br /> STK2637311 <br /> (Please use the back of this sheet for additional comments or cc iv 05/20/2026 07:33:38 <br /> III IIIII IIIIIIIIIIIIIIIIII III�I <br /> AK26%73SR41 <br />
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