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ARCHIVED REPORTS_XR0009193
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_XR0009193
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Entry Properties
Last modified
5/6/2020 11:47:28 AM
Creation date
5/6/2020 11:25:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009193
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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• Cham I of Custody Number y �5� � <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento E3 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 05 Task# 0410 Analysis Request <br /> Protect Manager Jaff Auchterlonie <br /> Laboratory _Krff Analytical 40 <br /> m <br /> Turnaround Time Standard <br /> e <br /> Samples Name Pen V � �' m <br /> s a � �N :a� � o � ° <br /> Sampler's Signature e S e o ^� m o 9 n m Comments) <br /> CL n E4o m 1E1 �`� <br /> U a a o a Q c�7 o N $o E ' rj a Instructions Z <br /> Sample ID Date Time Matrix z � c I- a > m = w <br /> MW-2 -ZS-a— S Water x x I I x -o l 3 <br /> MW-3 rYo Water x X X -o2- 3 <br /> MW-4 1 s Water x X x -03 3 <br /> ' MW-5A ,y Water x X X -V! 3 <br /> % MW-5B r3S3 Water x X X 3 <br /> Special Instructions/Comments Relinquished by, ec,& Received by Sample Receipt <br /> 5 Oxygenates- TAME,MtBE, ELBE,TBA,DIPE Sign Sign Total no of containers <br /> Global ID#70607700407(SIRC) Print Print Chain of custody seats <br /> email EDD to dacatlin@secor com Company Sfn a f Compan Recd in good condition/cold <br /> email results to dherzog@secor com and Time Date, Z m e Ti Date Conforms to record <br /> tmiller@secor com Relinquished by Received by <br /> Sign Sign Client SECOR <br /> Print Print Client Contact Tom Miller <br /> Com pa Company 6,%W 414,A06E, Client Phone (916)86140400 <br /> Ti Date Time pDate p 80� ext.279 <br /> sEcw`cuc ve Date '2 rp Page ' <br />
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