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Environmental Health - Public
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3500 - Local Oversight Program
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PR0545727
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SITE INFORMATION AND CORRESPONDENCE
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Last modified
6/3/2020 4:31:36 PM
Creation date
6/3/2020 4:01:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
RECORD_ID
PR0545727
PE
3528
FACILITY_ID
FA0005693
FACILITY_NAME
7-ELEVEN INC. STORE #20680
STREET_NUMBER
9110
STREET_NAME
THORNTON
STREET_TYPE
Rd
City
Stockton
Zip
95209
CURRENT_STATUS
02
SITE_LOCATION
9110 Thornton Rd
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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4080 PIKE LANE. SUITE C CHAIN-OF-CUSTODY RECORD <br /> GT E L <br /> CONCORD, CA 94520 AND ANALYSIS REQUEST 37110 .1 <br /> ly <br /> ���„a���ry„ (510) 685.7852 <br /> -� (800)423-7143 <br /> ANALYSIS OTHER'l <br /> Company Name: Phone 4:(y!L 371 J1170J <br /> c� <br /> GrdL ,tQu)JeJ, FAX #: !E 270- 7,P/ [W C) m f] <br /> Company Ac dress:/ 1 Site <br /> pLocation. _ _ <br /> Projecl Manager. Client Project ID: (N) n y� �' N 0F, d E) EI [ <br /> 2 ti '.�.. C ❑ J <br /> oa.o7c> -/37 C S-a'7' n H W a a <br /> m a [� ❑ C1 In z z ” ° n <br /> attest that the proper lield sampling Sampler Name(Print): 9 n cn rte; T ❑ Q = c L-1 n a <br /> procedures were used durin{}the / o Cl ui l] o J a meii u cw f_-I <br /> collection of Ihese samples. Al�� `� ❑ o n `y n 17 v a N [a N 5 <br /> 13 in <br /> Matrlx iL IA_ <br /> Method Sampling "' a 2 2 D <br /> Field GTEL z W Preserved Lm n 0 o Cl � a n � � � � <br /> Sample Lab M a yqfl EJ P <br /> a `J <br /> ID rLal)Usel 0 J O cc a W - & i w i w cc K 2S c ver ego w x !v = <br /> l only / u a o I a a riu- >. ; -° a- a a a a as a a a <br /> p 3 rn a us a Q x -- w Cr a 1= cn m r z O w w w w w w w w w w F w v o U <br /> 1177 <br /> (22- <br /> o]3 <br /> "J7_ — <br /> d <br /> i, <br /> 91�f-9..Cnnri,� --f25 Y <br /> 1 23L-16 ftlat 06 <br /> 7171-ILtil«_ — <br /> ItG��� Up -- - - --- - C- - - - -- --- - -- - -- — <br /> 77 <br /> TAT Special Handling SPECIAL DETECTION LIMITS REMARKS. <br /> Priority(24 hr) t I GTEL Contact <br /> Expedited(48 hr) 1.1 Quote/Coniracl q <br /> 7 Business Oats 1.1 Canliunallon <br /> Business Days (..I P O• k _ SPECIAL REPORTING REQUIREMENTS Lab Use Only Lot c Storage Location <br /> QA/QC Level 5 vG <br /> Blue I I CLP(.) other 1.1 _ _ FAX❑ Work Order 8: <br /> Relinquished by Sampler• a1s Time Receive by: <br /> ' <br /> CUSTODY <br /> RECORD Relinquished . �y Zte Time Receive by: <br /> z � <br /> Relinquished by; Dale Time Received by Laboratory: <br /> 91 if )-Z Waybill 9 i <br />
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