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Environmental Health - Public
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EHD Program Facility Records by Street Name
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3500 - Local Oversight Program
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PR0545246
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Last modified
1/30/2020 4:08:49 PM
Creation date
1/30/2020 1:52:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545246
PE
3528
FACILITY_ID
FA0003611
FACILITY_NAME
PARKWOODS GAS & FOOD
STREET_NUMBER
1612
Direction
W
STREET_NAME
HAMMER
STREET_TYPE
LN
City
STOCKTON
Zip
95209
APN
07728002
CURRENT_STATUS
02
SITE_LOCATION
1612 W HAMMER LN
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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COOLER RECEIPT CUE �,JAST Curti& Vonnpkues Lid. , <br /> i <br /> Logia !# o2/�, !_C/ _ Date Received 3131 IMNurnber of coolers_ <br /> Clients �`�► �l f`? -- -_ Project <br /> Date Opened -31471 By(pnnt)M_JiLL WWL&- (sign) — <br /> Date Logged in By(print) GlL7l� _(sig <br /> 1. Did cooler come with a stripping slip(airbill, � _ YES <br /> Shipping info <br /> ZA. Were custody seats present? __. ❑YES (circle) on cooler on samples ❑ <br /> How many Name _ Date_ <br /> 2B. Were custody seals intact upon arrival? YES NO <br /> 3. Were custody papers dry and intact when received? NO. <br /> 4. Were custody papers filled out properly(ink, signed, etc)? NO <br /> 5. Is the project identifiable from custody papers?(If so hill out top of form)_ NO <br /> 6. Indicate the packing in cooler: (if other,describe) <br /> ❑Bubble Wrap ❑Foam bloats 01rag-s ❑None <br /> ❑Cloth material Q Cardboard ❑Styrofoam ❑Paper towels <br /> 7. Temperature documentation: <br /> Type of accused: , Wet ❑Blue/Gel ❑None Temp(-C) <br /> Samples Received on ice&cold without a temperature blank <br /> p Satrapies received on ice directly from the Feld. Cooling process had begun <br /> 8. Were Method 5035 sampling containers present? YES Aw <br /> If YES, what time were they transferred to freezer? <br /> 9. Did all bottles arrive unbroken/unopened?� _ NO <br /> 10. Are samples in the appropriate containers for indicated tests? YA NO <br /> 11. Are sample labels present, in goal condition and complete? NO <br /> 12. Do the sample labels agree with custody papers? NO <br /> 13. Was stif#icient amount of sample sent for tests requested? NO <br /> 14. Are the samples appropriately preserved? YES <br /> 15. Are bubbles >6mm absent in VOA samples? YES NO I <br /> 16. Was the client contacted concerning this sample delivery? YES NO <br /> If YES, Who was called? By Date: <br /> COMMENTS <br /> r <br /> SOP Volume:' Client Services Rev. 6 Number i of 3 <br /> Section: i.t.2 Effective: 23 July 2008 <br /> Page: 1 of I Z_Igclformslchecklists�Cooler Receipt Checldist_rv6.doc <br /> �, of <br />
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