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3500 - Local Oversight Program
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PR0545347
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Last modified
2/6/2020 3:55:53 PM
Creation date
2/6/2020 3:15:32 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545347
PE
3528
FACILITY_ID
FA0003685
FACILITY_NAME
DBA CIRCLEK, REFUEL PETROLEUM INC.
STREET_NUMBER
419
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21938610
CURRENT_STATUS
02
SITE_LOCATION
419 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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Ar on Laboratories S <br /> am le Recei t Checklist <br /> Client Name Gorr¢0 r <br /> Date&Time Received <br /> Project Name: <br /> c+�- M C2 n+e cc`�o _B / o / Cl-3 f�- �FS- <br /> Client Proiect <br /> Received By: )4 1.1 rNumber 3�6 f q <br /> a rr, <br /> Sample Carver I LabMatrix: ale / Soil / <br /> orafo / FedEx / UPS / <br /> Argon Labs Project Number. CS r f, <br /> Shipping Container/Coder in good condition? <br /> Samples received in proper coma;Wars? <br /> WA-Yes � No Yes / No <br /> Samples received under refrigeration? Samples received intact? <br /> Sufficient <br /> Yes No <br /> sample volume for requested tests? <br /> Yes / No � <br /> Cham of Custody Present? YesYes / <br /> / No SNo <br /> Cham of Custody signed by all parties? Samples received within holding time? YeS <br /> Do samples contain proper preservative? �C No <br /> Yes No <br /> Cham of Custody matches all sample labels? N/A_ <br /> Yes No <br /> Do VOA vials contain zero headspace? <br /> Yes No <br /> (None submitted Yes No <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Client Contacted: 08/07 /03 <br /> Contacted by <br /> Person Contacted: Daur d <br /> }-}-i ra m <br /> Subject: D A nQ s i r <br /> Comments Co , .�c�J <br /> -D r c r1+ <br /> i <br /> 4 <br /> Acuon Taken <br /> } <br /> OTHER <br /> Date Client Contacted: <br /> Person Contacted: <br /> Comments: <br />
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