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COMPLIANCE INFO_2021
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231604
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COMPLIANCE INFO_2021
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Entry Properties
Last modified
8/16/2023 4:46:10 PM
Creation date
2/3/2021 2:42:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2021
RECORD_ID
PR0231604
PE
2361
FACILITY_ID
FA0000650
FACILITY_NAME
GAS & SHOP
STREET_NUMBER
1002
STREET_NAME
FRONTAGE
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
26102012
CURRENT_STATUS
01
SITE_LOCATION
1002 FRONTAGE RD
P_LOCATION
05
P_DISTRICT
004
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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vCD JENT6Ak'Py <br /> l ® A lei A L V T I C A L <br /> SAMPLE ACCEPTANCE CHECKLIST <br /> Section 1 <br /> Client: �17� "- W4sn �v��x.�N �-Project: 103 G& - C, A-/PO- 7 uc ?—" <br /> Date Received: 2/z5-"/-/ Sampler's Name Present: 2res DNo <br /> Section 2 <br /> Sample Temp('C) <br /> Sample(s)received in a cooler? Yes,How many? ( E]No(skip section 2) (No Cooler) <br /> Sample Temp(°C),One from each cooler: #1: `t{--� #2: #3: #4: <br /> (Acceptance range Is<6°C but not frozen(for Microbiology samples,acceptance range is<30'C but not frozen). It Is acceptable for samples collected <br /> the someday as sample receipt to have a higher temperature as long as there is evidence that cooling has begun.) <br /> Shipping Information: C t S <br /> Section 3 <br /> Was the cooler packed with: Dice E]Ice Packs ❑Bubble Wrap Styrofoam <br /> Paper ❑None Other <br /> Cooler Temp(°C): #1: 0-'7 #2: #3: #4: <br /> Section 4 YES NO N/A <br /> Was a COC received? <br /> Are sample IDs present? l <br /> Are sampling dates× present? <br /> Is a relinquished signature present? / <br /> Are the tests required clearly indicated on the COC? <br /> Are custody seals present? <br /> If custody seals are present,were they intact? <br /> Are all samples sealed in plastic bags? (Recommended for Microbiology samples) <br /> Did all samples arrive intact?If no,indicate in Section 4 below. / <br /> Did all bottle labels agree with COC?(ID,dates and times) / <br /> Were the samples collected in the correct containers for the required tests? / <br /> Are the containers labeled with the correct preservatives? l <br /> Is there headspace in the VOA vials greaterthan 5-6 mm in diameter? / <br /> Was a sufficient amount of sample submitted for the requested tests? <br /> Section 5 Explanations/Comments <br /> Section 6 <br /> For discrepancies,how was the Project Manager nottfled?QVerbal PM Initials: Date/Time <br /> Email (email sent to/on): / <br /> Project Manager's response: <br /> Completed By: Date: <br /> Enthalpy Analytical,a subsidiary of Montrose Environmental Group,Inc. <br /> 931 W.Barkley Ave,Orange,CA 92868•T:(714)771-6900•F:(714)538-1209 <br /> www.enthalpy.com/socal <br /> Sample Acceptance Checklist—Rev 4,8/8/2017 <br /> 6of48 <br />
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