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ARCHIVED REPORTS XR0006984
Environmental Health - Public
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EHD Program Facility Records by Street Name
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E
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103
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3500 - Local Oversight Program
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PR0544638
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ARCHIVED REPORTS XR0006984
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Last modified
7/9/2019 3:29:08 PM
Creation date
7/9/2019 2:22:15 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006984
RECORD_ID
PR0544638
PE
3528
FACILITY_ID
FA0004027
FACILITY_NAME
HENDRIX FORK LIFT INC
STREET_NUMBER
103
Direction
N
STREET_NAME
E
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15318001
CURRENT_STATUS
02
SITE_LOCATION
103 N E ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\wng
Tags
EHD - Public
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YJ <br /> Alpha Analytical, Inc. <br /> Phone (775)355-1044 FAX (775)355-0406 <br /> Sample Receipt Checklist <br /> Date Report is due to Client 3125/2004 Date of Notice 3/1712004 1 35 46 P <br /> Please take note of any NO check marks if we receive no response concerning these items within 24 hours of the date of this notice,all of <br /> the samples will be analyzed as requested <br /> Client Name Stratus Envtronmental Project ID Teichert <br /> Project Manager Steve Carter Clients Phone (530) 676-6008 Client's FAX (530)676-6005 <br /> Work Order Number STR04031743 Date Received 311712004 Received by Dolly S Baker <br /> Chain of Custody COC information <br /> Carrier name FedEx <br /> Chain of custody present? Yes �� No <br /> Custody seals intact on shippping containertrooler Yes V ❑ No Not Present F1 <br /> Custody seals intact on sample bottles? Yes 1 ❑ No Not Present r�� <br /> Chain of custody signed when relinquished and received? Yes W/I ❑ No <br /> Chain of custody agrees with sample labels? Yes ❑ No <br /> Sample ID noted by Client on COC? Yes �� ❑ No <br /> Date and time of collection noted by Client on COC? Yes ❑ No <br /> amplers's name noted on COC? Yes ❑ No <br /> d? Yes ❑ <br /> Internal Chain of Custody(GOC)requeste ❑� No <br /> None DV F-1SEMOther(see Comments) <br /> Sub Contract Lab Used ❑ <br /> Sample Receipt Information <br /> Shipping container/cooler in good condition? Yes 1/1 ❑ No Not Present ❑ <br /> Samples in proper container/bottle? Yes ❑ No <br /> Sample containers intact? Yes 1_Z ❑ No <br /> Sufficient sample volume for indicated test? Yes <br /> Wil ❑ No <br /> Sample Preservation and Hold Time HT Information <br /> All samples received within holding time? <br /> Yes ❑ No Cooler Temperature <br /> Container/Temp Blank temperature in compliance(0-6'C)? Yes <br /> �] ❑ No 4 GC <br /> submitted <br /> Water-VOA vials have zero headspace 1 no bubbles? <br /> Yes ❑ No No VOA vials ❑ <br /> Sample labels checked for correct preservation? <br /> Yes [:1 No <br /> TOC Water-pH acceptable upon receipt(H2SO4 pH<2)? Yes ❑ ❑ No NIA <br /> Ana! tial Re uirement Information <br /> Are non-Standard or Modified methods requested? Yes ❑ FV] No <br /> 1,71WI Na If YES see the Chain of Custody(COC) <br /> Are(here client specific Project requirements? Yes <br /> �amments <br />
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