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ARCHIVED REPORTS XR0003317
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 XR0003317
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Entry Properties
Last modified
6/28/2019 4:11:02 PM
Creation date
6/28/2019 2:03:15 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003317
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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t <br /> • i <br /> Chain of Custody Number <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 7-Eleven Store#20632 <br /> Rancho Cordova,CA Location 4627 Da Vinci Drive <br /> Stockton,Caitfornia <br /> Project# 77EL.20632 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Kiff Analytical m e <br /> Turnaround Time Standard d s m rn y <br /> Samplers Name T:. //,�, ` a <br /> Samplers SignatuT !$ o i � <br /> Comments/ <br /> Sample ID Date Time Matrix = a m >mHHm m m W Instructions z' <br /> MW-1 11 Yr Water X X al <br /> MW-2 1400 Water X X pZ <br /> MWS Jr 1-61 131x' Water X X S/ C <br /> MW-4R I-oz lq&tr Water X X <br /> MWS V-1-03 P3o Water X X y 05 <br /> MW-8 9r-/--.3 11 ds- Water X X <br /> MW-7 1 S30 Water X X 07 <br /> Special InstructionsfComments 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) Print Print Chain of custody seals <br /> EDF Deliverables Company Company Recd in good condition/cold <br /> emall results to bcarey@secor corn Time Date Tim Date Conforms to record <br /> Relinquished by- Receb <br /> Sign Sign Client SECOR <br /> Print Print tlkQ Client Contact Brian Carey <br /> Comp Company tt�a. lient Phone (916)861-0400 <br /> Date Time OPY-46 Date 0 03 ext,241 <br /> SEom CU37 enc rw 20 <br /> Date /` Page Ac I <br />
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