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ARCHIVED REPORTS_XR0009177
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_XR0009177
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Entry Properties
Last modified
5/6/2020 11:39:36 AM
Creation date
5/6/2020 11:21:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009177
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 /> Field Office 077 Sacramento L3 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 03 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Q <br /> Laboratory Kiff Arta cal <br /> Turnaround Time Standard a `� <br /> EL r_ a A (2 <br /> i � O <br /> Samplers Name Tom MiIlera am <br /> Sampler's Signature _ _ �, _ S X 9 m 01- Comments/ o <br /> _. 1 a <br /> Sample ID Date Time Matrix = °�- w � W N ° W Instructions z' <br /> MW-2 $-1YP3 33o Water X X - (31 <br /> MWS �=/5� /Y/S Water x x -n_L- Y <br /> MW-4 q=/y p� W Water X X -03 <br /> MW-6A 7=/ � / `/S Water X X -01 <br /> MW-0B TV91-3 a1 Water X X - o� <br /> Special Instructions/Comments Relinquished by?�— 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 /> EDF Deliverables(email to m koch @ secor.com) Company Company Rec'd in good oondition/cold <br /> email results to dherzog@secor.com Time 17cc) DatePP-r�-.a� Tl Date Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client SECOR <br /> Print Print Mico-tf e Client Contact. Bnan Carey <br /> Compan Company K+'EE 1'M��j +c_ Client Phone (916)861-0400 <br /> Ti Date Time l Date cwtgo) ext 241 i <br /> SECURCUSTRECRW ZW <br /> Date Page a,c <br />
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