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ARCHIVED REPORTS XR0003363
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 XR0003363
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Entry Properties
Last modified
6/24/2019 2:21:02 PM
Creation date
6/24/2019 1:28:01 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003363
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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Chain of Custody Number 'J f <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento 4OAdditional documents are attached,and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#14117 <br /> Rancho Cordova,CA Location 2725 Country Club Lane <br /> Stockton,CA <br /> Project# 7TEL..14117 03 Task# 0410 alysis Request <br /> Project Manager Jaff Auchterionie <br /> Laboratory Klff Analytical m <br /> Turnaround Time Standard49 <br /> Samplers Name %at*\ m� � � o e°a a o �'� � <br /> Sampler's Signature e a W $ <br /> o Comments/ <br /> Sample ID Date Time Matrix z > m ins#uctons Z <br /> 131 ABCD o Seo Soil X X -p} <br /> Special Instructions/Cornments Relinquished by R ived by Sample Receipt <br /> Combine loll samples SPI A,SP'1-B,SP1-C,and SP1- Sign Sign Total no of containers <br /> C Into one composite sample SP1{ABCD) Print l3r,ar� Print Chain of custody seals <br /> Company Cot Com Reed in good conddmVcold <br /> 5 Oxygenates.TAME, MtBE, EtBE,TBA,&DIPS Time gt� Date 1 V T e Date Conforms to record <br /> Global ID#TOW7700458(SIRC) Relinquished by Recenred byy <br /> small results to bcarey@secorcom Sign Sign �S� -��-� Client SECQR <br /> email EDF Deliverables to mkoch@secor.com Print Print Tri [ c%^ Client Contact Brian Carey <br /> Com Company Client Phone (916)86140400 <br /> Time Date Time (g0 o Date o lqa_3 ext.241 <br /> Sw=C=RwRW 20 <br /> I � � DateP� 03 Page�Abf 1 <br />
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