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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. 3`i 5 2 <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 74Eleven Store#14117 <br /> Rancho Cordova CA Location 2725 Country Club Lane <br /> Stockton,CA <br /> Project# 77EL14117.03 Task# 0410 alysis.Request <br /> Project Manager Jaff Auchterlonle a <br /> Laboratory Kiff Analytical ` e <br /> Turnaround Time Standard "i Q <br /> Sampler's Nam .11 ; 121 <br /> Samplers Signature ` $ a X Comments/ <br /> ° xe4 a a ffia a E <br /> Sample ID Daae Time Matrix = W1, IE ul z w w c w Instructions z' <br /> SBA wc4er , ' ! O -2-4C water X X X X I XIX ~ 4 <br /> SBA IRMwQer 'ii 1 11 4-v- Water x X1 x x I XIX -10 <br /> $191.1 wqw(- L471` (4cX) Water x X1 x x I x I x —7. <br /> SB-1 uj m 4r 300 Water X X X XI X X -ZZ <br /> Special Instructions/Comments Relinquished by Received by Sample Recei t <br /> 5 Oxygenates TAME,MtBE,ELBE,TBA,&DIPE Sign Sign Total no of containers <br /> Global ID#70607700458(SIRC) Print Br i Print Cham of custody seals <br /> email results to bcarey@secor.com Company c, Company Recd in good condibon/cold <br /> email EDF Deliverables to mkoch@socor.com Time t800 Dake b Time Date Conforms to record <br /> NI Sa -61 ai SSAW.J t ron AJIverea #o Relinquished by Received bb <br /> #®1a V ti-PR s.5&Rv P D Sign Sign VI. •---r Client SECOR <br /> Print Print St.w. Client Contact Bnan Carey <br /> Company Company c.,,} Client Phone (gig 8614400 <br /> Time Date Time 42Lxt _Date 0 4TI cf aT ext.241 <br /> SE=aasr►wftV xrw <br /> Date Page "f 3 <br />
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