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ARCHIVED REPORTS_XR0008890
Environmental Health - Public
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EHD Program Facility Records by Street Name
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V
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VAN BUREN
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424
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3500 - Local Oversight Program
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PR0545786
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ARCHIVED REPORTS_XR0008890
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Entry Properties
Last modified
6/1/2020 2:49:10 PM
Creation date
6/1/2020 2:10:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008890
RECORD_ID
PR0545786
PE
3526
FACILITY_ID
FA0004969
FACILITY_NAME
CHASE CHEVROLET
STREET_NUMBER
424
Direction
N
STREET_NAME
VAN BUREN
STREET_TYPE
ST
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
424 N VAN BUREN ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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' SOP Volume Client Services <br /> Section 1 1 2 <br /> Page 11 <br /> Effective Date 10-May-99 Cb Curtis &Tompkins ltd <br /> Revision 1 Number l of 3 <br /> Filename F 1QC\Forms\QC\Cooler wpd <br />' COOLER RECEIPT CHECKLIST <br /> I <br />' Login# 7a� J Date Received -5-' �"0 q Number of Coolers <br /> Client t s-e jvee-t l 1 - -0110 __ Project__ Project p Sq 7, ) 0 <br /> A Preliminary Examination Phase !! � <br /> Date Opened -riO-�� By (print) (q W'J 0C (stgn) <br /> 1 Did cooler come with a shipping slip (airbill, etc )7 YES O <br /> If YES, enter carrier name and airbill number <br /> 2 Were custody seals on outside of cooler? YES N <br /> How many and where? Seal date Seal name <br /> 3 Were custody seals unbroken and intact at the date and time of arrival? YES NO N/I <br /> 4 Were custody papers dry and intact when received? � NO <br />' 5 Were custody papers filled out properly (ink, signed, etc )9 <SID NO <br /> 6 Did you sign the custody papers in the appropriate place? NO <br /> 7 Was project identifiable from custody papers? Q NO <br /> If YES, enter project name at the top of this form <br /> 8 If required, was sufficient ice used? Samples should be 2-6 degrees C NO <br /> Type of ice Temperature 7 <br /> B Login Phase r }} � ff <br /> Date Logged In. -Q By (print) T WI�tAsyr (sign) <br />' 1 Describe type of packing in cooler IVI Pc <br /> 2 Did all bottles arrive unbroken` N <br /> 3 Were labels in good condition and complete (ID, date, time, signature, etc )9 <br /> 4 Did bottle labels agree with custody papers? YES cC�D <br /> 5 Were appropriate containers used for the tests indicated' NO <br /> 6 Were correct preservatives added to samples9 YES NOA114 <br /> 7 Was sufficient amount of sample sent for tests indicated? .�NO <br /> 8 Were bubbles absent in VOA samples? If NO, list sample Ids below YES NOA114 <br />' 9 Was the client contacted concerning this sample delivery? YES NO <br /> If YES,'give details below <br /> Who was called? By whom? Date <br /> Additional Comments <br /> �`pc[VG� { 743 c nd� ✓!c, �a <br /> {r t <br /> L-1 30 14,57 <br /> y (� �, ►ods IO�f f <br /> rFilename F lgcVormslgcicoolerdoc Rev 1,4195 <br />
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