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ARCHIVED REPORTS_XR0003831
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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PR0545420
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ARCHIVED REPORTS_XR0003831
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Entry Properties
Last modified
3/5/2020 6:22:29 PM
Creation date
3/5/2020 4:31:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003831
RECORD_ID
PR0545420
PE
3528
FACILITY_ID
FA0003815
FACILITY_NAME
TESORO (SPEEDWAY) 68154
STREET_NUMBER
2500
Direction
W
STREET_NAME
LODI
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
02740006
CURRENT_STATUS
02
SITE_LOCATION
2500 W LODI AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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Alpha Analytical, Inc. <br /> Phone: (775)355-1044 FAX :(775)355-0406 <br /> Sample Receipt Checklist <br /> Date Report is due to Client: 5113102 bate of Notice: 513!02 10:10:32 AM <br /> Please take note of any Non-Compliant check marks. If we receive no response concerning these items within 24 hours of the date of this <br /> notice,all of the samples will be analyzed as requested. <br /> Client Name Stratus Environmental <br /> Project 1D: 2007-0065-01!USA 65 <br /> Project Manager: Gowrl Kowtha Client's Phone <br /> (530)876-6002 Client's FAX (530)676-6005 <br /> Work Order Number: STR02050321 Date Received:513!02 <br /> Received by: Graciela Navarrete <br /> Chain of Custody COC Information <br /> Carrier name: Golden State Overnight <br /> Chain of custody present? Yes ,yj <br /> No <br /> Custody seals intact on shippping container/cooler? Yes y3 <br /> No Not Present <br /> Custody seats intact on sample bottles ? Yes <br /> .--" No Not Present <br /> Chain of custody signed when relinquished and received ? Yes ❑ No <br /> Chain of custody agrees with sample labels? <br /> Yes V ❑ Non-Compliant <br /> Internal Chain of Custody(COC)requested? yes ❑ ® No <br /> Sub Contract Lab Used : "None ® ❑ SEM Other(see comments) <br /> Sample Receipt Information <br /> orhipping container/cooler in good condition? Yes V No Not Present <br /> Samples in proper container/bottle? Yes V r_11 Non-Compliant <br /> Sample containers intact? Yes i❑ No <br /> Sufficient sample volume for indicated test? Yes ® ❑ No <br /> Sample Preservation and Hold Time fHTJ Information <br /> All samples received within holding time? Yes k ❑ Non-Compliant <br /> Container/Temp Blank temperature in compliance 0-6°C ? Yes - Cooler Temperature <br /> p ( ) R :_..s Non-Compliant 4'C <br /> Water-VOA vials have zero headspace? Yes VNon-Compliant No VOA vials submitted <br /> TOC Water•pH acceptable upon receipt? Yes <br /> No NIA dei <br /> TOC Samples should have a pH<2(H2SO4) <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested? Yes No <br /> Are there client specific Project requirements? Yes �F <br /> i� No If YES :see the Chain of Custody(COC) <br /> Comments <br />
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