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ARCHIVED REPORTS XR0000726
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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CAMBRIDGE
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16470
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3500 - Local Oversight Program
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PR0544155
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ARCHIVED REPORTS XR0000726
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Last modified
2/15/2019 5:35:29 PM
Creation date
2/15/2019 1:54:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000726
RECORD_ID
PR0544155
PE
3526
FACILITY_ID
FA0000185
FACILITY_NAME
CITY GAS & LIQUOR
STREET_NUMBER
16470
STREET_NAME
CAMBRIDGE
STREET_TYPE
ST
City
LATHROP
Zip
95330
APN
19643032
CURRENT_STATUS
02
SITE_LOCATION
16470 CAMBRIDGE ST
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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WNg
Tags
EHD - Public
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® STL <br /> --)STL: San Francisco <br /> Sample Receipt Checklist <br /> qbmission # 2403- � - � <br /> Checklist completed by (Initials) /0 rtials}� Date 1 / -3-/03 <br /> Courier name ❑ STL San Francisco ❑ Client �v�� 1� <br /> Not <br /> Custody seals intact on shipping containeriSam pies Yes No Present <br /> Chain of custody present? Yes o <br /> Chain of custody signed when relinquished and received? Yes__�_�o <br /> o <br /> Chain of custody agrees with sample labels? Yes_z N <br /> Samples in proper containerlbattle? <br /> Yes /No � <br /> Sample containers intact? Yes �No <br /> Sufficient sample volume for indicated test? Yes_ZNe <br /> All samples received within holding time? /� Yes-�No <br /> Containerfremp Blank temperature in compliance (40 C f 2)? Temp 1 -(,OC Yes -'�__No <br /> Ice Present Yes <br /> Water- VOA vials have zero headspace? No VOA vials submitted Yes <br /> No <br /> (if bubble is present refer to approximate bubble size and itemize in comments as S (small -O), M (medium - O) or L (large- V:1 <br /> Water- pH acceptable upon receipt? Yes ❑ No <br /> C] pH adjusted- Preservative used ❑ HNO3 ❑ HC! ❑ HZSO4 ❑ NaOH ❑ ZnOAc-Lot#(s) <br /> For any item check-listed "No", provided detail of discrepancy in comment section below <br /> Comments <br /> Project Management [Routing for instruction of indicated dlscrepancy(ies)] <br /> Project Manager (initials) Date 1d3 <br /> Client contacted C Yes ❑ No <br /> Summary of discussion <br /> doorrective Action (per PM/Client) <br />
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