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COMPLIANCE INFO_2020
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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2300 - Underground Storage Tank Program
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PR0518458
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
10/14/2021 1:42:41 PM
Creation date
1/17/2020 12:05:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0518458
PE
2361
FACILITY_ID
FA0013918
FACILITY_NAME
CHEVRON STATION #210997*
STREET_NUMBER
1442
STREET_NAME
COLONY
STREET_TYPE
Dr
City
RIPON
Zip
95366
APN
26102028
CURRENT_STATUS
01
SITE_LOCATION
1442 Colony Dr
P_LOCATION
05
P_DISTRICT
005
QC Status
Approved
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SJGOV\kblackwell
Tags
EHD - Public
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�j 1534 Willow Pass Road, Pittsburg, CA 94565- 1701 <br /> McCampbell Analytical Inc . Toll <br /> Vl Free Telephone: (877) 252-9262 / Fax: (925) 252-9269 <br /> " When Quality COunts " http://www.mccampbell.com / E-mail: main@�nccampbell.com <br /> Sample Receipt Checklist <br /> Client Name : GHD Services, Inc. Date and Time Received : 1 /22/2020 16 : 30 <br /> Project: 11208412 ; Ripon Replacement Date Logged : 1 /22/2020 <br /> Received by: Kena Ponce <br /> WorkOrder Ne : 2001909 Matrix: Soil Logged by: Kena Ponce <br /> Carrier: Client Drop- In <br /> Chain of Custody (COC) Information <br /> Chain of custody present? Yes W No ❑ <br /> Chain of custody signed when relinquished and received? Yes W No ❑ <br /> Chain of custody agrees with sample labels? Yes ❑d No ❑ <br /> Sample IDs noted by Client on COC ? Yes 0 No ❑ <br /> Date and Time of collection noted by Client on COC? Yes P1 No ❑ <br /> Sampler's name noted on COC? Yes 0 No ❑ <br /> COC agrees with Quote? Yes ❑ No El NA ❑d <br /> Sample Receipt Information <br /> Custody seals intact on shipping container/cooler? Yes ❑ No ❑ NA d❑ <br /> Shipping container/cooler in good condition? Yes ❑d No ❑ <br /> Samples in proper containers/bottles? Yes W No ❑ <br /> Sample containers intact? Yes W No ❑ <br /> Sufficient sample volume for indicated test? Yes W No ❑ <br /> Sample Preservation and Hold Time ( HT) Information <br /> All samples received within holding time? Yes 0 No ❑ NA ❑ <br /> Samples Received on Ice? Yes No ❑ <br /> (Ice Type : WET ICE ) <br /> Sample/Temp Blank temperature Temp : 2 . 2° C NA ❑ <br /> Water - VOA vials have zero headspace / no bubbles ? Yes ❑ No ❑ NAW <br /> Sample labels checked for correct preservation? Yes 0 No ❑ <br /> pH acceptable upon receipt (Metal : <2 ; Nitrate 353 .2/4500NO3 : Yes ❑ No ❑ NAW <br /> <2 ; 522 : <4 ; 218 . 7: > 8) ? <br /> UCMR Samoles : <br /> pH tested and acceptable upon receipt (200 . 8 : :52 ; 525 . 3 : 54 ; Yes ❑ No ❑ NA <br /> 530 : :57; 541 : <3 ; 544: <6 . 5 & 7 . 5) ? <br /> Free Chlorine tested and acceptable upon receipt (<O . 1 mg/L)? Yes ❑ No ❑ NA W <br /> — — — — — — — — — — — — — — — <br /> Comments : <br /> L H "AL F( 1 <br /> IV D <br /> J1 11 o 2 2. 020 <br /> ENVIRONMENTAL HEALH Page 36 of 36 <br /> nf= n .A 'nTMENT <br />
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