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WP0043537
Environmental Health - Public
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MICKE GROVE
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4200/4300 - Liquid Waste/Water Well Permits
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WP0043537
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Entry Properties
Last modified
6/26/2024 11:12:26 AM
Creation date
6/5/2024 2:19:56 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0043537
PE
4366
STREET_NUMBER
11250
Direction
N
STREET_NAME
MICKE GROVE
STREET_TYPE
RD
City
LODI
Zip
95240-
APN
05914069
ENTERED_DATE
7/27/2022 12:00:00 AM
SITE_LOCATION
11250 N MICKE GROVE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\gmartinez
Tags
EHD - Public
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FGL Environmental Doc ID:3DO900002_SOP_14.DOC <br /> Revision Date: 10/10/23 Page 1 of 1 <br /> Inter-Laboratory Cond7d:- 1i <br /> pon Receipt (Attach to COC) ����� <br /> Sample Receipt at: CC CHVI <br /> 1. Number of ice chests/packages receiv _ Shipping tracking#(s): ' <br /> 2. Temp IR Gun ID #: <br /> 3. Were samples received on is Yes o Temps. I I I I <br /> Surface water SWTR bact samples. p e that has a temperature upon receipt of X10°C,whether iced or not, <br /> should be flagged unless the time since sample collection has been less than tw <br /> 4. Do the number of bottles received agree with the COC? No N/A <br /> 5. Were samples received intact? (i.e. no broken bottles, leaks et . No <br /> 6. VOAs checked for Headspace? No N/A <br /> 7. Were all analyses within holding times at time of receipt? No <br /> 8. Verify sample date,time and sampler name es No <br /> Sign and date the COC,place in a ziplock and put in a ice c e samples. <br /> Sample Receipt Review completed by (initials): <br /> Sample Receipt at SP: <br /> 1. Number of ice chests/packages received: Shipping tracking#(s): 0 to <br /> 2. Temp IR Gun ID#:T h7.,(' <br /> 3. Were samples received on ice? Yes No Temps: <br /> Acceptable is above freezing to 6°C. If any packages are received at one time check for tests/H.T.'s/rushes/ <br /> 4. Do the number of bottles received agree with the COC? 1Le„s, No N/A <br /> 5. Were samples received intact?(i.e. no broken bottles, leaks etc.) Ye_a, No <br /> Sign and date the COC, obtain LIMS sample numbers, select methods/tests and print labels. <br /> Sample Verification,Labeling and Distribution: <br /> 1. Were all requested analyses understood and acceptable? Yes No <br /> 2. Did bottle labels correspond with the client's ID's? Yes+ No <br /> 3. Were all bottles requiring sample preservation properly preserved? Yes No SLA) FGL <br /> [Exception:Oil&Grease,VOA and CrVI verified in lab] <br /> 4. VOAs checked for Headspace? QLe-s/ No N/ <br /> 5. Have rush or project due dates been checked and accepted? Yes No N <br /> 6. Were all analyses within holding times at time of receipt? Yes No <br /> Attach labels to the containers and include a copy of the COC for lab deliv6e. <br /> Sample Receipt, Login and Verification completed by(initials): L <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 /> Resollktion: <br /> 2. Person Contacted: Phone Number: <br /> Initiated By: Date: <br /> Problem: <br /> Resolution: (3017919) <br /> San Joaquin CountyEHD <br /> (Please use the back of this sheet for additional comments or contac STP437396 <br /> cda 05/23/2024 09:05:57 <br /> 1(111111111111111111111111 <br /> QTVIA77144 <br />
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