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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 Custod Number. I <br /> SECOR Chain-of Custody Record <br /> Field Office: 077 Sacramento ® Additional 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 Cou <br /> Club lane <br /> Stockton,CA <br /> Project# 77EL.14117.03 Task# 0410 w rA6i Analysis Request <br /> Project Manager Jaff Auchtedonie a <br /> Laboratory Kiff Analytical W a g z <br /> Tumaround Time Standard e <br /> C <br /> Sampler's Name C3m <br /> c� <br /> Sampler's Signature ` <br /> a n <br /> Sample ID Date Time Matrix z r z o a Comments/ a <br /> Instructions z <br /> MW-8 r 43 Soil X X L- D1 <br /> MW-8 ID 062S Soil X 1X <br /> MW^5 1 0$30 Soil X X <br /> MW-8 ZO' 08357 Soil X X X <br /> MW-8. 2-51 0940 Soil X X <br /> MW-81 30Q94s sail X X L <br /> MWSl. 3:5;'_ kso Soil X X X <br /> MWS Lio 101sv- Soil X X <br /> MW-8 4 ' 0400 soil X X X <br /> MW-8 $C�" 0457 Soil X X X <br /> Special lnstructionslComments Relinquished b .: :Print <br /> ed by: Sample Receipt <br /> 5 Oxygenates.TAME,MtBE,UBE,TBA,&DIPE Sign Total no.of containers: <br /> Global ID#70607700458(SIRC) Print r I Chain of custody seals: <br /> email results to bcarey@secor.com Company - n Recd in good oondition/oolcl: <br /> email EDF Deliverables to mkoch@secor.com Time*J.Kw Date S 1 o Date Conforms to record: <br /> Rel' uished by. Received by. <br /> Sign Sign `�:. ..�- Client: SECOR <br /> Pnnt Print Client Contact: Brian Care <br /> Company Company Client Phone: 916 861-0400 <br /> Time Date Time Ihn--Date &K t q 03rext.241 <br /> soa cus�c . <br /> Date: ( 03 Page 1 of 3 <br />
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