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ARCHIVED REPORTS XR0000741
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 XR0000741
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Entry Properties
Last modified
2/15/2019 3:56:19 PM
Creation date
2/15/2019 2:01:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0000741
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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EHD - Public
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SrTL <br /> STL San Francisco <br /> /nSample Receipt Checklist <br /> 4kubmission #:2044- <br /> Checklist completed by: (initials) Date: 104 <br /> Courier name: Tl_San Francisco ❑ Client <br /> Not <br /> Custody seals i tact on shipping container/samples Yes No Present <br /> Chain of custody present? Yes No <br /> Chain of custody signed'when relinquished and received? Yes�_ZNo_ <br /> Chain of custody agrees with sample labels? Yes_,.ZNo <br /> Samples in proper container/bottle? Yes �o <br /> Sample containers intact? Yes <br /> Sufficient sample volume for indicated test? <br /> ` Yes J E`fo <br /> All samples received within holding time? Yes No <br /> . �+:g"e�^",yam .'.�'�." �r� r!c= ` q t-s. ,w:'' e» -„�, .'�e E7�.t•: x+� ��_'Ti @..5�"�T. 3.'i px:... <br /> Cod{gal lerf7empy,Biank`��teFl3 rr�tltl [tf C�fif�p1140CB`i 4� �- M e-. - <br /> _ t �. e <br /> sv.psi:?Y+;. "f&N` y"s - r _; s, 46 �s` a"v' as•� .�c 't '" r £_`$ ,��- Sx. ,�4 x �e rr na..,t <br /> ,;ys,. c tsA-, "aa' j. �` .p r" u�'„' �' 3.:5gh., Y aw3' .. �du�, �"�. 'f.'.' `' S - °a, 1 <br /> mom ' §r ;�. ?� <br /> t <br /> f?otentlllr�eason frx 6C` `led trrtf {I .Ie�r 'ads ;;N enoug( ,ree 17Nattrrugi r r []�Sarntesn.bo - <br /> NAM v <br /> {4{` &.ytr .1<- AJ% "1'. .e. <br /> a?D� <br /> ,,,,' K,,'F°.,�, � �' �s� , �'. . . a'✓ .. s��� ,L d3.i_Mb.. �"p;. ...�:' ,rCP,.LSE x3:.&.�:Ez <br /> �ater-VOA vials have zero headspace? Na VOA vials submitted Yes Na <br /> (if bubble is present, refer to approximate bubble size and itemize in comments as S (small-O), M (medium— O) or L(large-- O) <br /> Water-pH acceptable upon receipt? ❑ Yes ❑ No <br /> ❑ pH adjusted— Preservative used: ❑ HNO3❑ HCI ❑ H2SO4 ❑ NaOH ❑ZnOAc—Lot#(s) <br /> t " <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 disc repancy(ies)] <br /> Project Manager: (initials) Date: 1 104 Client contacted: ❑ Yes ❑ No <br /> -' Summary of discussion: <br /> Worrective Action (per PM/Client): <br />
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