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WP0045141 (2)
EnvironmentalHealth
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12 (STATE ROUTE 12)
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4200/4300 - Liquid Waste/Water Well Permits
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WP0045141 (2)
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Entry Properties
Last modified
11/5/2026 8:40:47 AM
Creation date
10/12/2026 7:51:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
File Section
COMPLIANCE INFO
RECORD_ID
WP0045141
PE
4366 - WELL DOMESTIC - </= 2 ACRE FT/YEAR
STREET_NUMBER
10943
Direction
E
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240-
APN
05115059
CURRENT_STATUS
Closed
QC Status
Approved
Scanner
SJGOV\gmartinez
Supplemental fields
Site Address
10943 E STATE ROUTE 12 LODI 95240-
Tags
EHD - Public
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I <br /> i <br /> FGL Environmental Doc ID:2D2600009_SOP_15.DOC <br /> Revision Date:08/18/26 Page 1 of 1 ' <br /> Inter-Laboratory Condition-Upon Receipt (Attach to COC) p;p5#7 g <br /> Sample Receipt at: CC CH (�' KVI <br /> 1. Number of ice chests/packages received: I Shipping tracking#(s): <br /> 2. Temp IR Gun ID#: TH318 C ection Factor: 0 <br /> 3. Were samples received on is Ye o Corrected Temps: <br /> Surface water SWTR batt samples:A sample that has a temperature upon receipt of LJO C,whether iced or not, <br /> should be flagged unless the time since sample collection has been less than t o 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.) Yes No <br /> 6. VOAs checked for Headspace? N N/A <br /> 7. Were all analyses within holding times at time of receipt? No <br /> 8. Verify sample date, time and sampler name Yes <br /> 9. Custody Seals intact? es No N/A <br /> 10. Sample Receipt Review completed by(initials): <br /> Sample Receipt at SP: <br /> 1. Number of ice chests/packages received: Shipping tracking#(s): 4K1L4& ►� <br /> 2. Temp IR Gun ID#: Correction Factor: ' <br /> 3. Were samples received on ice? es No Corrected Temps: <br /> Acceptable is above freezing to 6°C. If 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? No N/A <br /> 5. Were samples received intact? (i.e. no broken bottles, leaks etc.) a3 No <br /> 6. Custody Seals intact? Yes No D/ <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? fes <br /> No <br /> 3. Were all bottles requiring sample preservation properly preserved? No FGL* <br /> [Exception:Oil&Grease,VOA and CM verified in lab] *Samples preserved in lab <br /> 4. VOAs checked for Headspace? Yes No M <br /> 5. Have rush or project due dates been checked and accepted? Yes No 2D <br /> 6. Were all analyses within holding times at time of receipt? CJ No <br /> Attach labels to the containers and include a copy of the COC for lab OeIivery. <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: --- <br /> Initiated By: (3017919) <br /> Problem: San Joaquin CountyEHO <br /> Resolution: STK2654538 <br /> (Please use the back of this sheet for additional cot iv 09/24/202615:50:39 <br /> [II f[I[I[If[I�[i[If[I[[If[I[II[[f I I[II <br /> STKM4$S8 <br /> 1 <br />
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