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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 <br /> SECOR Chain-of CuStody Record <br /> Field Office 077 Sacramento 0 Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#20632 <br /> Rancho Cordova,CA Location 4627 DaVincl Dr <br /> Stockton,CA <br /> Project# 77EL20632.04 Task# 0410 Analysis Request <br /> Protect Manager Jaff Auchterionle <br /> Laboratory Kill Analytical m <br /> Turnaround Time Standard Q �' <br /> 4 GG VVV <br /> Sampler's Name Damon Brown x m -2 <br /> $ Q ar no <br /> Sampler's Signature <br /> mN _ a asp � m <br /> a 3: a� E o n m E a O a o a Comments! s <br /> no <br /> Sample I© Date Time Mafix F a m m = $ ', r instructions z <br /> 1 <br /> 5g -' j Q i a t 7'30 Ltk'&e! Y <br /> S Q 4 C ilf3t l 6'r�o <br /> 9, A- r�3r l0'P wadi X I It <br /> Q-40 Wt+y <br /> 56 -3 V4 <br /> 13 4v waf rc ! <br /> 5 g —3G ` 14 Zo u� I <br /> i <br /> Special InstructionslComments Relinquished by Received by —,,Sample Receipt <br /> Sign Sign Total no of containers <br /> email results to- dbrown@secor com Print Mmon Brown Pnnt Chain of custody seals <br /> dherzog@secor com Company SECORpan <br /> Time y Recd�n good candrhonlcaid <br /> l b z o Date o Time Date Conforms to record <br /> Relinquished by Received by <br /> 1 Sign Sign Client SECOR <br /> Print Print G Client Contact Jaff Auchterlonie <br /> Cony Company Kiff Anal cal Client Phone 1916)861-WO <br /> i e Date TimeDate 6 7 ext.223 <br /> sr,IM CUBTF&c Rn gee <br /> Date 01/31/05 Page 101`1 <br />
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