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ARCHIVED REPORTS XR0003311
Environmental Health - Public
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EHD Program Facility Records by Street Name
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D
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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 XR0003311
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Entry Properties
Last modified
6/28/2019 4:19:54 PM
Creation date
6/28/2019 1:55:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003311
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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Chain of Custody Number I�aZca <br /> SECOR Chain-of Custody Record Z -Z <br /> Field Office 077 Sacramento Q Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgore Road,Sude 100 Job Name 7-Eleven Store 020632 <br /> Rancho Cogav CA Location 4627 DaVincl Dr <br /> SWcktan,CA <br /> Project# 77EL20632.04 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Klff Analytical <br /> Tumamund Time Standard x <br /> Sampler's Name Damon Brown <br /> Samplers Signature c n m ° o ` s <br /> a _ x � � <br /> � Espa <br /> Comments/ <br /> Sample ID Date Time Matrix = r- ►a- m >g =S A b w M w Instructions <br /> S6— ie, - 01/31/06 17If.$' Soil X X ( 1 <br /> 1131 IV 75 50.i <br /> 131 +S SS Saar p <br /> 56 �3 a rla� 13," 5,0.1 X <br /> g 3C 1`1110 5.0 <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> Sign Sign Toth no of containers <br /> emall results to dbrown@secor corn Print Damon Brown Print Chain of custody seals <br /> dherzog@secor corn Company SECOR Com Recd in good conddaVcold <br /> Time 16_,zcp Date z Date Conforms to reoord <br /> Relinquished by Received bYA— <br /> Sign Sign Client SECOR <br /> Pont Print Client Contact Jaff Auchtetlonle <br /> Comp an Compa Kiff Analytical Client Phone (916)$61-0430 . <br /> Time Date TimeDate _ ext.223 <br /> Date 01131105 Page 1 of 1 <br />
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