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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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�i Chain of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office: 077 Sacramento ® Additional documents are attached, and are part of this Record. <br /> Address: 3017 10gore Road,Suite 100 Job Name: 7-Eleven Store#14117 <br /> Rancho Cordova,CA Location: 2725 Country Club Lane <br /> Stockton,CA <br /> Project# 77EL14117.03 Task# 04..10 ... Anal is Request <br /> Project Manager Jaff Auchterlonle a <br /> Laboratory _ Kiff Analytical <br /> m <br /> Turnaround Time Standard g o <br /> m � - 4C* C <br /> Sampler's Name t 'a4\ Ca. z a <br /> Sampler`s Signature a i3 4 Y a a a <br /> IL N m d =a. Comments/ <br /> Sample ID Date Time Matrix x 1- 9 .- a w z � u. lu G su Instructions z <br /> SBA wctitr- 2' ' 1 D3ago Water X x X X X X <br /> SB-1 $f$wo3%- 3I I 12 y s- Water X X I X X X1 X <br /> SBA wq-Wr ' 14M) Water X x x x x x <br /> SB 1 %,w 3 SOO Water X x x X X X <br /> Special Instructions[Comments Relinquished by: Received by: Sample Receipt <br /> 5 Oxygenates:TAME,MtBE,EtBE,TBA,&DIPE SignSign Total no.cf containers: <br /> Global ID#TOW7700458(SIRC) Print Br i a Print Chain of custody seals: <br /> email results to bcarey@secor.com Company SGoQ- Company Recd In good conditionteold: <br /> small EDF Deliverables to mkoch@secor.com Time IWO Date Time Date Conforms to record: <br /> ASI Sa �or S-.&- i ron clo U\rer4 1-0 Relinquished by. Received by: <br /> {�b 4)V-PR T5-5;SRV IPp Sign Sign Client: SECOR <br /> t Print Print melApi S-w. Client Contact: Brian Care <br /> Company Company ve.,g An"Iel Ment Phone: 910 8614MO <br /> Time Date Time 4113. -Date 0 qr 5r03� ext.241 <br /> Date: 4811 a3 Page 3 of 3 <br />
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