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ARCHIVED REPORTS_XR0007426
Environmental Health - Public
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EHD Program Facility Records by Street Name
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P
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PACIFIC
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6131
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3500 - Local Oversight Program
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PR0545003
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ARCHIVED REPORTS_XR0007426
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Last modified
11/27/2019 11:38:35 AM
Creation date
11/27/2019 11:23:26 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0007426
RECORD_ID
PR0545003
PE
3526
FACILITY_ID
FA0002324
FACILITY_NAME
Pacific Service Station
STREET_NUMBER
6131
STREET_NAME
PACIFIC
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
09746418
CURRENT_STATUS
02
SITE_LOCATION
6131 PACIFIC AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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SJGOV\wng
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EHD - Public
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1 <br /> COOLER RECEIPT FORM <br /> rokct: Log No: 1 <br /> ooler receive on: and checked on `1 by <br /> j sia ure <br /> ere custody papers present? . . . . . . . . . . . . . . . . . . . . . . . . . . . .AIE5' NO <br /> ere custody papers properly filled out? . . . . . . . . . . . . . . . . . . .4-E37 NO <br /> ere the custody papers signed' . . . . . . . . . . . . . . . . . . . . . . . . . . .YES- NO <br /> assufficient ice used' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y-Ls NO <br /> id all bottles arrive in good condition (unbroken) ' . . . . . . ..: E NO <br /> yid bottle labels match COC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YES NO <br /> sere proper bottles used for analysis indicated' . . . . . . . . . . . Y-.r NO <br />'orrect preservatives used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Y-£SS NO <br /> IOA vials checked for headspace bubbles' . . . . . . . . . . . . . . • • • •YES, NO <br /> Note which voas ( if any) had bubbles: * <br />,ample descriptor: Num�—r of vials: <br /> W^ <br />*All VOAs with headspace bubbles have been set aside so they will not be <br /> usedfor analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . YES NO <br /> List here all other fobs received in the same cooler: <br /> 1e�1t Job # - NET <br /> •S, <br /> . (coolerrec) <br />
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