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WP0040785
Environmental Health - Public
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EHD Program Facility Records by Street Name
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12 (STATE ROUTE 12)
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4200/4300 - Liquid Waste/Water Well Permits
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WP0040785
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Entry Properties
Last modified
11/19/2024 3:48:25 PM
Creation date
11/12/2021 10:07:51 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0040785
PE
4366
STREET_NUMBER
26606
Direction
E
STREET_NAME
STATE ROUTE 12
City
CLEMENTS
Zip
95227-
APN
02322005
ENTERED_DATE
5/4/2020 12:00:00 AM
SITE_LOCATION
26606 E HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2020
Tags
EHD - Public
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FGL Environmental Doc ID: 3DO900002_SOP_12-3.DOC <br /> Revision Date: 10/09/14 Page 1 of 1 <br /> Inter-L tory Condition Upon Receipt (Attach to COC) ��J�' <br /> Sample Receipt at: STK CC CH VI <br /> 1. Number of ice ch packages received: Shipping tracking# <br /> 2. Were samples received in a chilled condition? Temps: �/ <br /> Surface water SWTR bact samples: A sample that has a temperature upon receipt of >10'C,whether iced or not, <br /> should be flagged unless the time since sample collection has been less than two hours. <br /> 3. Do the number of bottles received agree with the COC? No N/A <br /> 4. Were samples received intact? (i.e. no broken bottles, leaks etc.) Y No <br /> 5. VOAs checked for Headspace? Yes No _ <br /> 6. Were sample custody seals intact? Yes No <br /> 7. If required, was sample split for pH analysis? Yes No <br /> 8. Were all analyses within holding times at time of receipt? No <br /> 9. Verify sample date, time and sampler name Ye No <br /> Sign and date the COC, place in a ziplock and put in t e e ice chest as the samples. <br /> Sample Receipt Review completed by (initials): <br /> Sample Receipt at SP: <br /> 1. Were samples received in a chilled condition? Temps: <br /> Acceptable is above freezing to 6E C. if many packages are received <br /> a�tt one time check for tests/H.T.'s/rushes/ <br /> 2. Shipping tracking numbers: <br /> 3. Do the number of bottles received agree with the COC? No N/A <br /> 4. Were samples received intact? (i.e. no broken bottles, leaks etc.) ges No <br /> 5. Were sample custody seals intact? Yes No <br /> Sign and date the COC, obtain LIMS sample numbers, select methods/tests and print labe s. <br /> Sample Verification, Labeling and Distribution: <br /> 1. Were all requested analyses understood and acceptable? No <br /> 2. Did bottle labels correspond with the client's ID's? No <br /> 3. Were all bottles requiring sample preservation properly preserved? No N/A FGL <br /> [Exception:Oil&Grease,VOA and CrVI verified in lab/ <br /> 4. VOAs checked for Headspace? Yes No <br /> 5. Have rush or project due dates been checked and accepted? Yes No <br /> 6. Were all analyses within holding times at time of receipt? )5 No <br /> Attach labels to the containers and include a copy of the COC for lab delivery. <br /> Sample Receipt, Login and Verification completed by (initials): <br /> Discrepancy Documentation: <br /> Any items above which are "No" or do not meet specifications (i.e. temps) must be resolved. <br /> 1. Person Contacted: Phone Number: <br /> Initiated By: Date: <br /> Problem: <br /> Resolution: <br /> 2. Person Contacted: (3017919) <br /> Initiated By: San Joaquin County EHO <br /> Problem: STP154077Resolution: <br /> iv 09/30/2021 16:12:59 ere <br /> (Please use the back of this sheet for addition, III <br /> IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII <br /> contacts) STK2154077 <br />
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