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ARCHIVED REPORTS_XR0012536
Environmental Health - Public
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EHD Program Facility Records by Street Name
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W
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WILSON
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130
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3500 - Local Oversight Program
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PR0545892
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ARCHIVED REPORTS_XR0012536
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Last modified
7/22/2020 2:50:14 PM
Creation date
7/22/2020 2:43:43 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012536
RECORD_ID
PR0545892
PE
3528
FACILITY_ID
FA0003601
FACILITY_NAME
ARCO STATION #826951*
STREET_NUMBER
130
Direction
S
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205-5561
APN
15502064
CURRENT_STATUS
02
SITE_LOCATION
130 S WILSON WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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LSauers
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EHD - Public
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i <br /> SEQUOIA ANALYTICAL SAMPLE RECEIPT LOG <br /> CLIENT NAME: F3• .� DATE RECD AT LAB' _ For Regulatory Purposes? <br /> BY(PRINT) TIME RECD AT LAB. DRINKING WATER YE N <br /> WORKORDER- DATE LOGGED IN- WASTE WATER YES NO <br /> CIRCLE THE APPROPRIATE RESPONSE LAB IDA#SH <br /> _ CONTAINER PRESERV1 SAMPLE DATE REMARKS <br /> SAMPLE# C4 ENT ID DESCRIPTION ATIVE t'H {MATRIX SAMPLED CONDITION(ETC) � <br /> 1 Custody Seals) t/Absent l_ W Y L <br /> ftnta /Broken* <br /> 2 Chain-of-Custody e t I Absent* <br /> 3 Traffic Reports or <br /> Parking Inst res nt/Absent - 3 <br /> 4 AirbilE I/Sticker <br /> e t/Absent I- <br /> 8 Atrbill# $ <br /> 6 Sam le Labels res nt/Absent <br /> 7 Sample IDsEste /Not Lasted <br /> on Chain-of-Cost <br /> 8 Sample Cond[tlon Q�5 1 Broken* <br /> L.eakin * <br /> 9. Does information on chain-af-custody, <br /> traffic reports and sample labels <br /> e ree? /No* ` v <br /> 14 Sample received within v <br /> hold time? e /No* W '" <br /> 11 Adequate sample volume <br /> received? /Ne SLl vomit <br /> 12 Pro er preservatives used e /No* <br /> 13 Tnp Hlan Te Is ece,ved? <br /> Yet;!No* <br /> 14 Read Temp � <br /> Corrected Temp <br /> Is correctedtemp 4�1-2°C? (Yue' /Ne* <br /> (Acceptance range for samples requtdng thermal Fres? <br /> **Exception(if any) MEALS l DFL=ON ICE <br /> or Problem COC <br /> *IF CIRCLED,CONTACT PROJECT MANAGER AND ATTACH RECORD OF RESOLUTION. t <br /> evislon 7 Page 1 <br /> ces Rev 5(07it3/04) <br />
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