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COMPLIANCE INFO_2020
Environmental Health - Public
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0544527
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
9/10/2020 4:52:15 PM
Creation date
9/10/2020 4:48:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0544527
PE
1609
FACILITY_ID
FA0025313
FACILITY_NAME
FOX FARMS
STREET_NUMBER
131
Direction
S
STREET_NAME
CORINTH
STREET_TYPE
AVE
City
LODI
Zip
95242
CURRENT_STATUS
01
SITE_LOCATION
131 S CORINTH AVE
P_LOCATION
02
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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FGL Environm ntal Doc ID:3DO900002_SOP_12 MDOC <br /> Revision Date: i /09/14 Page 1 of 1 <br /> nter- ry Condition.Upon,Receipt(Attach to COC) oJ7J`-J�3� <br /> Sample Recei t at: STK CC CH VI <br /> 1. NumbJe <br /> ce c packages received: Shipping tracking 4 <br /> 2. Were ss received in a chilled condition? Temps: t/tT <br /> SurfaceSWTR bact samples:A sample that has a temperature upon receipt of >10*C,whether iced or not, <br /> should be flagless the time since sample collection has been less than two hours. <br /> 3. Do thbei of bottles received agree with the COC? No N/A <br /> 4. Were es received intact?(i.e. no broken bottles, leaks etc. Yes No <br /> 5. VOAked for Headspace? . Yes No <br /> 6. Weree custody seals intact? Yes No7. If reqwas sample split for pH analysis? Yes8. Were alyses within holding times at time of receipt? Cle <br /> N <br /> 9. Verifyle date,time and sampler name No <br /> Sign and date e COC,place in a ziplock and put i the same ice chples. <br /> Sample Recei t Review completed by (initials):. <br /> Sample Recei t at SP: r� <br /> 1. Were sa iples received in a chilled condition? Temps: <br /> Acceptabl is above freezing to 6 ji C. If many packages arc received at one time check for tesls/H.T.'s/tushesl <br /> 2. Shippin tracking numbers: <br /> I 00-7U`? -t- qqr750uCK-) <br /> 3. Do the timber of bottles received agree with the COC? fes <br /> No N/A <br /> 4. Were ples received intact?(i.e. no broken bottles, leaks etc.) No <br /> 5. Were ple custody seals intact? No 03 <br /> Sign and date the COC,obtain LIMS sample numbers, select methods/tests and print labels. <br /> Sample Veri cation,Labeling and Distribution: <br /> 1. Were al requested analyses understood and acceptable? No <br /> 2. Did bo le labels correspond with the client's ID's? a No <br /> 3. Were al bottles requiring sample preservation properly preserved? No N/A FGL <br /> IExeeption:Oil&Grease,VOA and CM verified in labl <br /> 4. VOAs hecked for Headspace? Yes No <br /> 5. Have h or project due dates been checked and accepted? Y No / <br /> 6. Were al analyses within holding times at time of receipt? (9 No <br /> Attach labels to the containers and include a copy of the COC-for lab"d livery. <br /> Sample Rece pt, Login and Verification completed by (initials): Q.f/ <br /> Discrepancy Documentation: <br /> Any items a ove which are"No"or do not meet specifications(i.e. temps)must be resolved. <br /> 1. Person ontacted: Phone Number: <br /> Initiat By: Date: <br /> Proble <br /> Resolu ion: <br /> 2. Person Contacted: (3-18303) <br /> Initial By: <br /> Proble Laura Boyce <br /> Resol ion: <br /> STK2935535C"` <br /> lease use a back of this sheet for additional com: 1ere <br /> �' SRP-04/24/2020-16:39:13 <br /> contacts) <br />
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