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ARCHIVED REPORTS_XR0005247
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545495
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ARCHIVED REPORTS_XR0005247
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Last modified
3/10/2020 6:52:20 PM
Creation date
3/10/2020 4:25:48 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0005247
RECORD_ID
PR0545495
PE
3528
FACILITY_ID
FA0006423
FACILITY_NAME
STOCKTON MOBIL 2
STREET_NUMBER
3440
Direction
E
STREET_NAME
MAIN
STREET_TYPE
ST
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
3440 E MAIN ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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'r Clvrarca <br /> nWranmental <br /> ALaborarorlea. Inc. WORK ORDER #: 04 - 21E - F010[2�ij <br /> 4- <br /> Cooler of <br /> SAMPLE RECEIPT FORK! <br /> CLIENT: DATE: 2 + L/ <br /> TEMPERATURE — SAMPLES RECEIVED BY: <br /> CALSCIENCE COURIER: LABORATORY (Other than Calsctence Courier). <br /> Chilled, cooler with temperature blank provided 'C Temperature blank <br /> Chilled, cooler without temperature blank "C IR thermometer <br /> Chilled and placed in cooler with wet ice Ambient temperature <br /> Ambient and placed in cooler with wet ice <br /> Ambient temperature <br /> °C Temperature blank Initial <br /> CUSTODY SEAL INTACT <br /> Samples) Cooler �N No(Not Intact) Not Applicable (NIA) <br /> Initial <br /> SAMPLE CONDITION <br /> Yes No NIA <br /> Cham-Of-Custody document(s) received with samples �- <br /> Sample container Iabel(s) consistent with custody papers <br /> Sample container(s) intact and good condition .� <br /> Correct containers for analyses requested <br /> Proper preservation noted on sample label(s) _ <br /> VOA vial(s) free of headspace <br /> Tedlar bag(s) free of condensation <br /> Initial <br /> COMMENTS: <br />
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