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ARCHIVED REPORTS_XR0009187
Environmental Health - Public
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EHD Program Facility Records by Street Name
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P
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PERSHING
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4501
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3500 - Local Oversight Program
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PR0545651
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ARCHIVED REPORTS_XR0009187
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Entry Properties
Last modified
5/6/2020 11:37:16 AM
Creation date
5/6/2020 11:22:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009187
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 [3 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 /> 0 <br /> Laboratory Ktff Analyitcal N <br /> Turnaround Time Standard s i <br /> Samplers Name sr !$/l+dl'1 .-�51 83 :'0g <br /> Samplers Signature N fl ' g ` <br /> o !, _ a a Comments/ <br /> Sample ID Date Time Matrix = m ae 8 V, z 8 't n instructions z <br /> MW-2 Water X X 1 <br /> MW-3 MY? Water X X 0� <br /> MW-0B NO Water X X 03 <br /> MW-4 /l Y� Water X X <br /> MW-5A Water X X B <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) PrintfAAD S,�40 Print Chain of custody seals <br /> EDF Deliverables Company 34zewt Compan Recd in good condition/cold <br /> email results to bcarey@secor.com Time ty Date_j 47c3 Date Conforms to record <br /> Relinquished byReceiv by <br /> Sign Sign Alent SECOR <br /> Print Print Client Contact Brian Care <br /> Company Company Client Phone 916 861-0430 <br /> Time Date Time I to j�S ext 241 <br /> SECOR CUSTMC Aw 7189 <br /> Date �i�]�3 Page <br />
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