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ARCHIVED REPORTS_XR0004444
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004444
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Last modified
2/6/2020 4:42:27 PM
Creation date
2/6/2020 3:46:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004444
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 Laborafiories Sample Receipt Checklist <br /> Client Name: Condor Earth Technolo ies, inc Date 8 Time Received: 9/28/2004 <br /> 16:30 <br /> Project Name: Bo ett Manteca Client Project Number: 3769 <br /> Received By: E.P. Matrix: Water ❑ <br /> ❑ Soil <br /> Sample Carrier: Client Laboratory ❑ Fed Ex ❑ UPS ❑ Other ❑ <br /> Argon Labs Project Number: E09631 <br /> Shipper Container in good condition? Samples received in proper containers? Yes Q No ❑ <br /> NIA Yes E No ❑ Samples received intact? Yes No ❑ <br /> Samples received under refrigeration? Yes E No ❑ Sufficient sample volume for requested tests?Yes Q No ❑ <br /> Chain of custody present? Yes 2 No Samples received within holding time? Yes No <br /> Chain of Custody signed by all parties? Yes 0 No ❑ Do samples contain proper preservative? <br /> NIA ❑ Yes No ❑ <br /> Chain of Custody matches all sample labels? 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: Person Contacted: <br /> Contacted By: Subject: <br /> Comments: <br /> Action Taken: <br /> ADDITIONAL TEST(5)REQUEST!OTHER <br /> Contacted By: Date: Time: <br /> Call Received By: <br /> Comments: <br />
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