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ARCHIVED REPORTS XR0003355
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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2725
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3500 - Local Oversight Program
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PR0544596
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ARCHIVED REPORTS XR0003355
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Entry Properties
Last modified
6/24/2019 1:59:26 PM
Creation date
6/24/2019 1:22:46 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003355
RECORD_ID
PR0544596
PE
3528
FACILITY_ID
FA0002064
FACILITY_NAME
7-ELEVEN INC. STORE #14117
STREET_NUMBER
2725
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
02
SITE_LOCATION
2725 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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• i <br /> Chain of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento [3 Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store 914117 <br /> Rancho Cordova,CA Location 2725 Country Club Blvd._ <br /> Stockton,California <br /> Project# 77EL14117 04 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonle <br /> Laboratory Ktff Analytical $ m <br /> Turnaround Time Standard d % <br /> Sampler's Name Pen V _ <br /> Samplers Signature =R k <br /> g X m Comments/ <br /> Sample ID Date Time Matrix = I&-- Instructions z' <br /> MW-1 °1-1{ -DY11 b H2O x X X 3 <br /> MW-2 13 5 H2O x x x -oz 3 <br /> MW-3 q /G-o 1535 H2O x X X —d3 3 <br /> MWS °/ /r,.-a y i� H2O x X X 3 <br /> MW-5 Iz55 H2O x X X —4S 3 <br /> MW-6 916-6Y H2O x X X 3 <br /> MW-7 -14 a H2O x X X J07 3 <br /> W8 -! -by H2O x X X —01 3 <br /> Special Instructions/Comments Relinqu;III <br /> Received by Sample Receipt <br /> 5 Oxygenates TAME,MtBE,EtBE,TBA,&DIPE Sign Sign Total no of containers <br /> Global ID#T0607700458(SIRC) Print Vpf4 h Pri Chain of custody seals <br /> email EDD dacatlin@secor com Company Si-e e,r Comp y Recd in good conddionlcdd <br /> email lab report to dhenog@secor com and Time Date_9-L •e Y Time Date Conforms to record <br /> tmiller@secor com Relinquished by 06 Remved b <br /> Pn Sign L Client SECOR <br /> Pn t Print Client Contact Tom Miller <br /> Co ny Company Client Phone (916)86140400 <br /> Time ate Time l� Dae 1 D ext.279 <br /> SEWA Cmmc rar asa <br /> Date b Y Page <br />
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