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ARCHIVED REPORTS_XR0006489
Environmental Health - Public
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EHD Program Facility Records by Street Name
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Y
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YOSEMITE
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1012
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3500 - Local Oversight Program
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PR0545948
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ARCHIVED REPORTS_XR0006489
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Last modified
9/29/2020 10:19:49 PM
Creation date
8/5/2020 3:52:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0006489
RECORD_ID
PR0545948
PE
3528
FACILITY_ID
FA0005159
FACILITY_NAME
FILL-EM FAST
STREET_NUMBER
1012
Direction
W
STREET_NAME
YOSEMITE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
21903024
CURRENT_STATUS
02
SITE_LOCATION
1012 W YOSEMITE AVE
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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LSauers
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EHD - Public
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Ar on Laboratories Sample Receipt Checklist <br /> Client Name A-TL Date&Time Received z 1 z& 14J-3 /-S0 <br /> Protect Name VAtS 5e.-va Client Project Number <br /> Received By' ?I ""? MatnxWater Soil 1 <br /> ' Sample Carrier Client 1 orato 1 FedEx 1 UPS 1 <br /> Argon Labs Project Number D Z V31 <br /> Shipping Container I Cooler in good condition? Samples received in proper containers? Yes No <br /> ' NIA_Z Yes IVa Samples received intact? Yes }` No <br /> Samples received under refngerabon? Sufficient sample volume for requested tests? <br /> Yes, No Yes> I No <br /> ' Chain of Custody Present? Yes _ No Samples received within holding time? Yes-;x— No <br /> Chain of Custody signed by all Parbes7 <br /> Do samples contain proper preservative? <br /> yes-�c No NIA Yes_ No <br /> Chain of Custody matches all sample labels? Do VOA vials contain zero headspace? <br /> Yes No (None submitted)Yeses_ No <br /> ANY"No"RESPONSE MUST BE DETAILED IN THE COMMENTS SECTION BELOW <br /> Date Ciient Contacted Person Contacted <br /> ' Contacted by Subject <br /> Comments <br /> Action Taken <br /> I { i <br /> OTHER <br /> Date Client Contacted Person Contacted <br /> ' Comments <br /> I <br /> i <br /> I <br /> t I <br /> I { � <br /> 4 E ill II ki f I I IIIc IV <br /> I I I �� v �I I• I� �I EI J n <br />
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