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ARCHIVED REPORTS XR0003315
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 XR0003315
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Entry Properties
Last modified
6/28/2019 3:33:46 PM
Creation date
6/28/2019 1:56:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003315
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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0 Chain of Custody Number <br /> SECOR Chain-o# Custody Record 3 40 � <br /> Field Office 077 Sacramento ❑ Additional documents are attached, and are part of this Record <br /> Address 301710Igore Road,Suite 100 Job Name 7-Eleven Store#20632 <br /> Rancho Cordova CA Location 4627 Da Vine Drive <br /> Stockton, California <br /> i <br /> Project# 77EL-20532 03 Task# 0410 alysis Req nest <br /> Project Manager Jaff Auchterlonie <br /> Laboratory _Klff Analytical <br /> Turnaround Time Standard .._ � o y <br /> ° <br /> Samplers Name , 5411-r` <br /> Samplers Signatunkm g ¢ a , ° <br /> 9 I <br /> R � Comments/ <br /> Sample ID Date Time Matrixs m ` S g W Instructions z <br /> MW-1 Water x X X 3 of <br /> MW-2 /530 Water x X X 3 Z <br /> MW-3 -i y y ?.Yr' Water x X X 3 IC3 <br /> MW-4R y /y/s' Water x X I X 3 " <br /> / MWS aY -00 Water x X X 3 <br /> 00 MW- 4)`V o 3 o Water x X X 3 01 <br /> MW-7 1-/a--aY s°O Water x X X 3 <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> 5 Oxygenates.TAME,MtBE, EtBE,TBA,& DIPE Sign Sign Total no of containers <br /> Global ID#70607700798(SIRC) Pnn Pint Chain of custody seas <br /> EDF Deliverables(email to deathn0seeor.com) Company Compa Recd in good condaion/cold <br /> email results to dherzog@secorcom Time Date Date Conforms to record <br /> Relinquished by Received by <br /> Sign Sign f.4,..� Client SECOR <br /> Pint PrintA Carey <br /> d �� �w Client Contact _Brian Can <br /> C. <br /> Company c Client Phone (916)861-0400 <br /> T Date Time Y02 - Datg2&say ext 241 <br /> SUO-9 CW,REC R«zw <br /> Date Page �c.�/ <br />
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