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ARCHIVED REPORTS_XR0002620
Environmental Health - Public
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EHD Program Facility Records by Street Name
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HARLAN
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15600
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3500 - Local Oversight Program
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PR0545273
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ARCHIVED REPORTS_XR0002620
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Entry Properties
Last modified
2/3/2020 6:26:49 PM
Creation date
2/3/2020 11:19:43 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002620
RECORD_ID
PR0545273
PE
3528
FACILITY_ID
FA0000174
FACILITY_NAME
JOES TRAVEL PLAZA
STREET_NUMBER
15600
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19620079
CURRENT_STATUS
02
SITE_LOCATION
15600 S HARLAN RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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Billing Info n CHAIN-OF-CUSTRY RECORD * Page J <br /> CA 2of2 <br /> Alpha Analytical, Inc. WorkOrder : STR04120640 <br /> 255 Glendale Avenue,Suite 21 Sparks,Nevada 89431-5778 <br /> Client TEL (775)355-1044 FAX (775)355-0406 Report Due By • 5:00 PM On - 14-Dec-04 <br /> Stratus Environmental Gown Kowtha <br /> 3330 Cameron Park Drive TEL (530)676-6002 EDD Required Yes <br /> Suite 550 FAX (530)676-6005 <br /> Cameron Park,CA 95682-8861 Job Joes Truck Plaza Sampled by Vince Z <br /> Report Attention Gown Kowtha PO Client's COC# 05754 Cooler Temp 4°C 06-Dec-04 <br /> CC Report <br /> QC Level S3 = Final Rpt,MBLK LCS MS/MSD With Surrogates <br /> Requested Tests <br /> Alpha Client Collection No of Bottles ALCOHOLw _ TPH1E—W TPHIPW voC_w <br /> j <br /> Sample ID Sample ID Matrix Date ORG SUB TAT PWS# Sample Remarks <br /> STRO4120640-10A1 MWO-3 AQ 12/02/04 1 9 0 6 McOIuEioH TPHIE-C aTXEIGAs BTXEIGAs — —— -- <br /> 08 45 05oxys/EDB C15oxyslEDB I <br /> i12DCA I12DCA <br /> STR04120640-11 A MWO-1 AQ 12/02/04 , 9 0 6 McOWBOH TPHIE_C BTXE/GAS_i BTXEIGAS <br /> 0910 C15oxysIEDBIC15orys1EDB <br /> /I21)CA Il2DCA <br /> Comments Samples received 12104104,samples kept cold&secure until tpe-in Custody seal Frozen ice Send copy of receipt checklist with final report <br /> Signature Print Name Company Date/Time <br /> Received byt <br /> , �Cex Alpha Analytical,Inc Ilan <br /> NOTE Samples are discarded 60 days after results are reported unless other arrangements are made Hazardous samples will be returned to client or disposed of at client expense <br /> The report for the analysis of the above samples is applicable only to those samples received by the laboratory with this COC The liability of the laboratory Is limited to the amount paid for the report <br /> Matrix Type AQ(Aqueous) AR(Air) SO(Soil) WS(Waste) DW(Drinking Water) OT(Other) Bottle Type L-Liter V-Voa S-Soil Jar O-Orbo T-Tedlar B-Brass P-Plastic OT-Other <br />
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