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ARCHIVED REPORTS_XR0009174
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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PR0545651
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ARCHIVED REPORTS_XR0009174
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Entry Properties
Last modified
5/6/2020 11:43:37 AM
Creation date
5/6/2020 11:20:34 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009174
RECORD_ID
PR0545651
PE
3528
FACILITY_ID
FA0002479
FACILITY_NAME
7-ELEVEN INC #17334
STREET_NUMBER
4501
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11017004
CURRENT_STATUS
02
SITE_LOCATION
4501 N PERSHING AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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• 0 Cham of Custody Number • <br /> SECOR Chain-of Custody Record 379yo <br /> Field Office 077 Sacramento U Additional documents are attached,and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#17334 <br /> Rancho Cordova,CA Location 4501 North Pershing Avenue <br /> Stockton,CA <br /> Project# 77EL 17334 04 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Kiff Analytical „ <br /> Turnaround Time Standard a U' m <br /> T � L� <br /> CL <br /> r- a0 :6 m U o La � <br /> Sampler's Name Tom Miller m m 091 <br /> m <br /> m o e'o Wo 160 C $ o <br /> cm <br /> Sampler's Signator Q = _ = E p m ,m I m 0 Comments) <br /> '� oa .9 a � <br /> Sample ID Date Time matrix = - � m >°w z w v, 0"0140 I I Instructions z <br /> MW-2 -7-y 1 0 Water x X X 3 <br /> MW-3 Y 7-.*Y 1 314r Water x X X 3 z <br /> MW-4 91 -7-0Y I Vo Water x X X 3 3 <br /> MW-SA 47-a /S Water x X X 3 <br /> MW-5B Y-7-ol g— Water x X X 3 <br /> i <br /> Special Instructions/Comments Relinquished b Received by Sample Receipt <br /> 5 Oxygenates TAME, MtBE,EtBE,TBA,DIPE Sign Sign Total no of containers <br /> Global ID#70607700407(SIRC) Print Print Chain of custody seals <br /> email EDD to dacatlin@secor cam Company Compan Recd in good conddion/cold <br /> email results to dherzog@secor corn and Time 2 Date p d8X/ Ti Date Conforms to record <br /> bcarey@secor cam Relinquished by Received by <br /> Sign Sign Client SECOR <br /> Print Print k'2 I Client Contact Brian Carey <br /> Pe <br /> Company - ClientPhone 916 881-0400 <br /> Date Time /Skg Date ext.241 <br /> SECM CUSnMC rM 2W Date ,/- 7-01-/ Page /��/ <br />
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