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ARCHIVED REPORTS_XR0003846
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_XR0003846
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Entry Properties
Last modified
3/5/2020 5:45:22 PM
Creation date
3/5/2020 4:34:21 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003846
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 Deport is due to Client 21912005 Date of Notice 21912005 B 06 32 AM <br /> Please take note of any NO check marks If we receive no response concerning these items within 24 hours of the date of this notice,all of <br /> the samples will be analyzer(as requested <br /> Client Name Stratus Environmental Project ID USA 65 <br /> Project Manager Gown Kowtha Client's Phone (530) 676-6002 Client s FAX (530) 676-6005 <br /> Work Order Number STRO5020901 Date Received 2/9/2005 Received by Stacy Marie Strock <br /> Chain of Custody(COC) Information <br /> Carrier name Aloha Employee <br /> Chain of custody present? Yes ❑ No <br /> Custody seals intact on shippping container/cooler? Yes ❑ ❑ No Not Present <br /> Custody seals intact on sample bottles? Yes ❑ ❑ No Not Present 0 <br /> Chain of custody signed when relinquished and received ? Yes 0 ❑ No <br /> Chain of custody agrees with sample labels 7 Yes ❑ No <br /> Sample ID noted by Client on COC? Yes No <br /> Date and time of collection noted by Client on COC? Yes ❑ No <br /> Samplers's name noted on COC ? Yes ❑ No <br /> Internal Chain of Custody(COC)requested? Yes ❑ 0 No <br /> Aub Contract Lab Used None R ❑ SEM Other(see comments) ❑ <br /> Sample Receipt Information <br /> Shipping containerlcooler in good condition? Yes 0 ❑ No Not Present ❑ <br /> Samples in proper containerlbottie? Yes �/❑ ❑ No <br /> Sample containers intact? Yes 0 ❑ No <br /> Sufficient sample volume for indicated test? Yes V ❑ No <br /> Sample Preservation and Hole!Time HT Information <br /> All samples received within holding time? Yes No <br /> Cooler Temperature <br /> Container/Temp Blank temperature in compliance(0 6°C)? Yesr/❑ ❑ No na°C <br /> Water-VOA vials have zero headspace/no bubbles? Yes No No VOA vials submitted ❑ <br /> Sample labels checked for correct preservation? Yes No <br /> TOC Water pH acceptable upon receipt(H2SO4 pH[2)? Yes ❑ ❑ No NIA 0 <br /> Analytical Requirement Information <br /> Are non-Standard or Modified methods requested ? Yes ❑ 0 No <br /> Are there client specific Project requirements? Yes ❑ S?) No If YES see the Chain of Custody(COC) <br /> Comments W 0 split due to different TATs on chain, see also 05020902 <br /> 0 <br />
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