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ARCHIVED REPORTS XR0003306
Environmental Health - Public
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EHD Program Facility Records by Street Name
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DA VINCI
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4627
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2900 - Site Mitigation Program
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PR0543804
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ARCHIVED REPORTS XR0003306
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Entry Properties
Last modified
6/28/2019 3:25:06 PM
Creation date
6/28/2019 1:53:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003306
RECORD_ID
PR0543804
PE
2950
FACILITY_ID
FA0024907
FACILITY_NAME
7-ELEVEN STORE #20632
STREET_NUMBER
4627
STREET_NAME
DA VINCI
STREET_TYPE
DR
City
STOCKTON
Zip
95207
CURRENT_STATUS
01
SITE_LOCATION
4627 DA VINCI DR
P_LOCATION
01
QC Status
Approved
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EHD - Public
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9 Chain of Custody Number: U �� <br /> SECOR Chain-of Custody Record <br /> Field Office: 077 Sacramento L) Additional documents are attached,and are part of this Record_ <br /> Address: 3017 Kilgore Road,Suite 100 __. Job Nate: 7-Eleven Store#20632 <br /> Rancho Cordova,CA Location: 4627 Da Vinci Drive <br /> Stockton,California <br /> Project# 77EL.20632.05 Task# 0410 Analys is R uest <br /> Project Manager Damon Brown <br /> Laboratory KW Analytical g e <br /> in m <br /> Turnaround Time Standard w a o CS <br /> o m ov <br /> Samplers Name Co ni 1- k v m �� � o <br /> ,p O ev � O - O a <br /> SamplerO E s Signature a 0 v S 8 m <br /> x z x E �' COmmentsl <br /> �Ud a 0. dSample ID ate Time Matrix x x w' <br /> oI* LUI Instructions z <br /> MW-1 Water x X X 3 �I <br /> MW-2 r7� Water x X X 3 <br /> MWS X03 Water x X X 3 "a <br /> MW-411 Water x X X 3 ro� <br /> MW-0 123 Water x X X 3 ro� <br /> MW4 Water x X X 3 '&t <br /> MW-7 Water x X X 3 <br /> Special Instructions/Comments Relinqui y' 1J Received by: Sample Receipt <br /> 6 Oxygenates:TAME,MtBE, EtBE,TBA,&DIPE Sign Sign Total no.of containers: <br /> Global ID#70607700798(SIRC) Print Print Chain of custody seals: <br /> email EDD to cryan@secor.com Company Compa Recd in good condition/cold: <br /> email results to dherzog@secorcom and TimeDate T' Date Conforms to record: <br /> dbrown@secor.com Relinquished by: Received by: <br /> Sign Sign - SECOR <br /> TOM ' Them.IDA Print Print Client Contact: Damon Brown <br /> tMWt Com Company �, )Client Phone: (816)861-0400 <br /> �° �—�� e Date Time r�1 b Date Zo ext 230 <br /> Coolant pr ll ! No <br /> GUM CUWrFZC ftw.ZW r1 <br /> Date: � � V Page _ <br />
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