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ARCHIVED REPORTS_XR0009175
Environmental Health - Public
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EHD Program Facility Records by Street Name
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PERSHING
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3500 - Local Oversight Program
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PR0545651
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ARCHIVED REPORTS_XR0009175
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Entry Properties
Last modified
5/6/2020 11:34:26 AM
Creation date
5/6/2020 11:20:53 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009175
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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Chain of Custody Number <br /> SECOR Chain-of Custody Record <br /> xField Office 077 Sacramento a Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 _ _ Job Name 7-Eleven Store#17394 <br /> Rancho Cordova, CA .- . Location 4501 North Pershing Avenue <br /> Stockton CA <br /> Project# 77EL.17334.03 Task# 0410 Ana is Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Kiff Analytical <br /> Turnaround Time Standard w o a <br /> Sampler's Name Tom Miller � 5 ' l R <br /> Sampler's Signature a _ m U <br /> Comments! <br /> Sample ID . Date Time Matrix z $ 9 : 81 Instructions <br /> MW-2 W/VIW #30 1 Water x X X �4 <br /> MW-3 3 i ,�IWater x X X —�Z <br /> M*4 a- / 3600o Water x X X <br /> MW-SA loY Water x X X <br /> MW.58 /3 Water x X X —pS <br /> Special Instnictions/Comments Relinquished by R ived by Sample Receipt <br /> 5 Oxygenates:TAME, MtBE,EtBE,TBA, DIPE Sign < Sign Total no of containers <br /> Global ID#T0607700407(SIRC) Print Print Chain of custody seals <br /> EDF Deliverables(email to dacatiin@secor com) Company Company,--' Recd in good conditiontoold <br /> email results to dherzog@secor com Time 11 Date C)IJ Ti Date Conforms to record <br /> Reliq,wished by -Received by <br /> Sign Sign �7i Client SECOR <br /> Print Print E Client Contact Bna_ nom_ <br /> Compa Company Client Phone (916)861-041 <br /> Time Date Time 17. Date oz roY ext.241 <br /> Date / v Page <br />
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