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ARCHIVED REPORTS_XR0004430
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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PR0545347
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ARCHIVED REPORTS_XR0004430
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Last modified
2/6/2020 4:56:24 PM
Creation date
2/6/2020 3:36:57 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004430
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 Sam le Receipt Checklist <br /> Client Name: ur� S <br /> — Date 8 Mme Received; <br /> Project Name: — fY+"'IECA Client Project Number. '3 +(o I A <br /> Received By: --p.'S , <br /> Matrix: Water Soil 1 <br /> Sample Carder: Client I Ahnrntnry FedEx ! UPS 1 <br /> Argon Labs Project Number: $ 1 1 <br /> Shipping Container I Coder in good conation? Samples received in proper containe ? Yest <br /> o <br /> NIA —,--'yes No Samples received intact? Yes ✓ <br /> No <br /> Samples received under refrigeration? Sufficient sample volume for requested tests? <br /> Yes No Yes Ll--- <br /> Chain of Custody Present? Yes ✓No Samples received within holding time? Yes %✓No <br /> Chain of Custody signed by all parties? Do samples contain proper preservative? <br /> Yes No NIA Yes L✓No <br /> Chain of Custody matches all sample la ? Do VOA vials contain zero headspace? <br /> Yes No (None submitted )Yes ✓ No <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Client Contacted; <br /> Person Contacted: <br /> Contacted by: Subject: <br /> Comments: j <br /> Action Taken: <br /> OTHER <br /> Date Client Contacted: Person Contacted: <br /> Comments: <br />
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