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ARCHIVED REPORTS_XR0009192
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_XR0009192
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Entry Properties
Last modified
5/6/2020 11:40:31 AM
Creation date
5/6/2020 11:24:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009192
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 L( 3�- • <br /> SECOR Cham-of Custody Record <br /> Field Office 077 Sacramento D Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store 017334 <br /> Rancho Cordova,CA Location 4501 North Pershing Avenue <br /> Stockton,CA <br /> Project# 77EL.17334 05 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterionie o <br /> Laboratory Kiff Analytical o e <br /> Turnaround Time Standard T ., <br /> oa R o s �, <br /> � m <br /> o <br /> ti � <br /> Sampler's Name Peng V z3 8 o �o 3 o a' s <br /> Sampler's Signature a 3 s eqr <br /> N a15- Cco Comments) <br /> Sam le ID Date Time Matrix x m a m z 2 ; ,� m Instructions z' <br /> ;W-2 - o ' 1330 Water x X X 3 vl <br /> / MW-3 1Y1L Water x X X 3 Q� <br /> MW-4 /(.31, Water x X X 3 03 <br /> MW-5A 1500 Water x X X 3 eY <br /> MW-5B ►S YL Water x X X 3 Of <br /> Special InstructionslComments Relinquished k �H Received by Sam le Receipt <br /> 5 Oxygenates:TAME,MtBE,EtBE,TBA,DIPE Sign Sign Total no of containers <br /> Global ID#70607700407(SIRC) Print K Print Chain of custody seals <br /> email EDD to cryan@secor cam Company -1 <br /> StCa C Company Recd in good condition/cold <br /> email results to dherzog@secor.com and Time Date -2-a< Time Date Confonns to record <br /> dbrown@secor cam Relinquished by eceived b <br /> Sign Sign Client SECOR <br /> Print Pint !( Client Contact Tom Miller <br /> Compan Company ) k Client Phone (916)861-0400 <br /> Ti Date Time UL —Date pyo s ext 279 <br /> SECOR auMc w.vac <br />� Date Page ! <br />
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