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ARCHIVED REPORTS_XR0009178
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_XR0009178
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Entry Properties
Last modified
5/6/2020 11:36:08 AM
Creation date
5/6/2020 11:22:00 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009178
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 J 7 l <br /> SECOR Chain-of Custody Record <br /> Field 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#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 /> Laboratory Kiff Ana heal Y <br /> C4 m N <br /> Turnaround Time Standard a H a 1 v <br /> Sampler's Name Tom Miller 0 <br /> I 's ' �, m <br /> o <br /> Samplers Signature Q v .m I i a <br /> Comments/ <br /> Sample ID Date Time Matmc $ g ° Instructions z' <br /> MW-2 ,]q/e,t Oyu Water X X bti <br /> MW-3 S1-191"- 1 Water X X a2 <br /> MW-5B IF001 Water X X L/ 03 <br /> MW-4 a a o] Water X )( oy <br /> MW-5Aa� <br /> VS' Water X X 0S <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#T0607700407(SIRC) Print Pant Chain of custody seals <br /> EDF Deliverables Company SC-la Compan Rec'd in good conddion/cold <br /> email results to bcarey@secor.com Time Date Time Date _ Conforms to record <br /> Relinquished by Receivedy N � <br /> Sign Sign Client SECOR <br /> Print Print NATO& I conS Client Contact Brian Care <br /> Compan Company ,k,,� Y , Client Phone 916 861-0430 <br /> Ti Date Time S $o b Date o Z I o%) ext 241 <br /> SECOR Cu6TREC Rear ZW <br /> Date Page 6 <br />
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