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REMOVAL_2007
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0527026
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REMOVAL_2007
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Last modified
4/28/2021 12:25:38 PM
Creation date
11/5/2018 12:57:59 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2007
RECORD_ID
PR0527026
PE
2361
FACILITY_ID
FA0018313
FACILITY_NAME
JOES TRAVEL PLAZA
STREET_NUMBER
15688
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19620077
CURRENT_STATUS
02
SITE_LOCATION
15688 S HARLAN RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\H\HARLAN\15688\PR0527026\REMOVAL 2007.PDF
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EHD - Public
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LIMS Lot# c t v�ov o PROJEC*I'tI2ECEIPT CHECKLIST Cont'd <br /> Fraction l-(o <br /> VOA LN <br /> H:HCL, S:H2SO4, N:HNO3, V:VOA, SL,Sleeve, E:Encore, PB:Poly Bottle, CGB:Clear Glass Bottle, AGJ:Amber Glass Jar, T:Tenacore <br /> AGB:Amber Glass Bottle, n/fA:HNO3-Lab filtered, n/f:HNO3-Field filtered, znna:Zinc Acetatc/Sodium Hydroxide, Na2s2o3:sodium thiosulfate <br /> Condition Upon Receipt Anomaly Form Anomalies DYES 0N1e <br /> • COOLERS • CUSTODY SEALS(COOLER(S) CONTAINER(S) <br /> C Not Received(received COC only) C None C None <br /> C Leaking C Not Intact C Not Intact <br /> C Other: C Other C Other <br /> • TEMPERATURE(SPECS 4 t 2eC) • CHAIN OF CUSTODY(COC) <br /> C Cooler Temp(s) C Not relinquished by Client;No date/time relinquished <br /> C Temperature Blank(s) C Incomplete information provided <br /> • CONTAINERS C Other C COC not received—notify PM <br /> C Leaking C Von Vials with Bubbles>6mm • LABELS <br /> C Broken C Not the same HI/info as in COC <br /> G Extra ❑Incomplete Information <br /> C Without Labels G MarkingsAnfo Illegible <br /> C Other: C Tom <br /> ' SAMPLES ❑Will he noted on COC—Client to send samples with new COC <br /> E Samples NOT RECEIVED but listed on COC C Mislabeled as to tests,preservatives,etc. <br /> C Samples received but NOT LISTED on COC C Holding Unit expired—list sample ID and test <br /> ❑Logged based on Label Information 13Improper container used <br /> C Logged based on info from other samples on COC C Not preserved/Improper preservative used <br /> C Logged according to Work Plan C Improper pH Lab to preserve sample and document <br /> C Logged on HOLD UNTIL FURTHER NOTICE C Insufficient quantities for analysis O Other <br /> Comments- <br /> 0 Corrective Action Implemented: <br /> C Client Informed:verbally on By: C In writing on By: <br /> C Sample(s)on hold until: O Sample(s)processed s is." <br /> Logged by/Date: Ied 1n by o er STL L]_ PM Revie ate: <br /> C �4(2� DI X06 <br /> Page 2 of 2 <br /> Page 65 of 84 <br />
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