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COMPLIANCE INFO
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2900 - Site Mitigation Program
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PR0543854
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COMPLIANCE INFO
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Entry Properties
Last modified
6/11/2021 4:58:27 PM
Creation date
6/11/2021 3:35:05 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0543854
PE
2960
FACILITY_ID
FA0024935
FACILITY_NAME
FORMER CHEVRON 94054
STREET_NUMBER
2103
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12308029
CURRENT_STATUS
01
SITE_LOCATION
2103 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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0 eurofins <br />Chevron California Region Analysis Request/Chain of Custody <br />f ( <br />Lancaster Laboratories <br />Environmental <br />For Eurofins Lnaster Laboratories Environpn1l_gsg_only <br />Acct. # CX0(,) Group #J t")70 Ta Sample # <br />Instructions on reverse side correspond with circled numbers. <br />Client Information Matrix _ <br /> Total Number of Containers I I Analyses Requested <br />SCR #: %Pgi6-4054-0ML G-R#17155216 Global1b#T0607700063 Soil E Sediment E I Potable El Ground X Water NPDES III Surface El • <br />.<7 <br />3 BTEX + MTBE 8021 0 82601g. TPH-GRO 8015 8260 0 P.16 LIPH-DRO 8015 without Silica Gel Cleanup TPH-DRO 8015 with Silica Gel Cleanup 0 8260 Full Scan Oxygenates Total Lead Method Dissolved Lead Method (- 0 e <br />1 <br />Ul <br />\---- <br />El Results in Dry Weight <br />CI J value reporting needed <br />CI Must meet lowest detection <br />limits possible for 8260 <br />compounds <br />El 8021 MTBE Confirmation <br />El Confirm highest hit by 8260 <br />1=1 Confirm all hits by 8260 <br />0 Run oxy's on highest hit <br />M Run oxy's on all hits <br />4 `itilgrtbUNTRY CLUB BLVD., STOCKTON, CA <br />Ctieron PM STANTECTF Liri109p6sultant <br />V64 brIVA0 n Inc., 6805 Sierra Court, Suite G, Dublin, CA 94568 <br />edg rill Pate:Mi'ding, deanna@grinc.com <br />7gsATtar- <br />6./ <br />444 x180 Composite Sampler <br />Soil Collected -0 Sample Identification Depth Date Time 0 Remarks <br />Qk 1-4125 — X 1/0 2- )C X Please forward the lab <br />results directly to the <br />Load Consultant and IV\114 - IA- k)-697C, 1410 ) X <br />IAW) ' M <br />li <br />it-too r, <br />,,, 13,0 <br />hAvJ -2- Ro92,5 loLiS— <br />I.Ata,-2 ( 5o5 <br />/ <br />.: V-kzo I _ YN-- k_23o s <br />MiAi -4 04)00 <br />ti l I3c i V V <br />Turnaround Time Requested (TAT) (please circle) <br />Standard 5 day 4 day <br />Relinquished by Date Time Received by <br />(---- ; ------A4-(r---6_,- <br />. <br />Date <br />5C07 <br />Time <br />/6/c/L/ <br />72 hour 48 hour 24 hour <br />Relin ished by <br />')--L?q-: <br />Dat Time <br />/6-3S2 <br />Received by <br />t) <br />Dale Time <br />Data Package (circle if required) EDF/EDD Relinquished by Date Time Received by Date Time <br />Type I - Full Type VI (Raw Data) <br />_--- ----- <br />Relinquished by Commercial Carrier: Received b Date Time <br />EDD (circle if required) UPS FedEx -: Other C eZ ci 1 1 9 1 1 <br />EDFFLAT (default) Other: Temperature Upon Receipt()A— k -F1 °C Custody Seals Intact? e) No <br />— Eurofins Lancaster Laboratories Environmental, LLCh J6hQr-l8l nd Pike, Lancaster, PA 17601 • 717-656-2300 <br />The white copy should accompany samples to Eurofins Lancaster Laboratories Environmental. The yellow copy should be retained by the client. 7050 0316
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