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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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0• Chain of Custody Number 3 SLI 9 B <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,California <br /> Project# 77EL 20632 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonis o <br /> Laboratory Kiff Analytical i3 a <br /> Q m <br /> a N� <br /> Turnaround Time Standard W C _ ICU <br /> O g� a0 U <br /> Sampler's Name � $ a �,o g o o n <br /> Sampler's Signature m W m 0 a 1 <br /> V a m <br /> x x V x E <br /> i;4 N �° a a Comments) E <br /> Sample ID Date Time Matrix z > _ 8 1"Co n W Instructions Z <br /> MW-1 03 1030 Water x X X 3 t <br /> MW-2 l a3 !2-y Water x X X 3 L <br /> MW-3 a I ///-S Water x X X 3 03 <br /> MW-4R /31S Water x X X 3 `{ <br /> MW-5 .? 206 Water x X X 3 DS <br /> MW-6 !oWA0 Ys- Water x X X 3 <br /> MW-7 Z d3 Water x X X 3 <br /> I <br /> Special InstructionslComments Relinquished by 0�1 oA!Vl,,f 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(email to dcatlin@secor com) Company Compa Recd in good condition/wId <br /> email results to dherzog@secor com Time Date T Date Conforms to reoard <br /> Relinquished by Receiv by- <br /> Sign <br /> ySign Sign Client SECOR <br /> Print Print bWN utt Client Contact Bnan Carey_ ._ <br /> CompCompany YGI�F- Client Phone (916)861-0400 <br /> Date Time y Date O ext.241 <br /> sKM cusTWc Fast Zvi <br /> Date ��� a 3 Page o — <br />
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