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COMPLIANCE INFO_2024
Environmental Health - Public
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EHD Program Facility Records by Street Name
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KENNEFICK
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1600 - Food Program
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PR0547668
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COMPLIANCE INFO_2024
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Entry Properties
Last modified
9/13/2024 10:51:34 AM
Creation date
9/13/2024 10:51:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0547668
PE
1608
FACILITY_ID
FA0027138
FACILITY_NAME
MAMA'S TOUCH SPECIALTY COOKIES
STREET_NUMBER
21600
Direction
N
STREET_NAME
KENNEFICK
STREET_TYPE
RD
City
ACAMPO
Zip
95220
CURRENT_STATUS
01
SITE_LOCATION
21600 N KENNEFICK RD
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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FGL Environmental <br />Revision Date: 10/10/23 <br />Inter-Laboratory Condi <br />Sample Receipt at: CC CH <br />1. Number of ice chests/packages received: <br />Doc ID: 3D0900002_5013_14.DOC <br />Page 1 of 1 <br />on Receipt (Attach to COC) oVIN 7dj6 <br />vi <br />Shipping tracking #(s): <br />Temp IR Gun ID #: .3 . g Were samples received on ic o Temps:eie , , <br />Surface water SWTR bact samples: p e 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 />Do the number of bottles received agree with the COC? <br />Were samples received intact? (i.e. no broken bottles, leaks etc. <br />VOAs checked for Headspace? <br />Were all analyses within holding times at time of receipt? <br />Verify sample date, time and sampler name <br />Sign and date the COC, place in a ziplock and put in the same ice ches <br />Sample Receipt Review completed by (initials): c 7 ..) <br />Sample Receipt at SP: <br />1. Number of ice chests/packages received: ( <br />Temp IR Gun ID #:(J <br /> 3. Were samples received on ice? es o Temps: f / / / <br />Acceptable is above freezing to 6°C. If many packages are received at one time check for lests/H.T.'s/rushes/ <br />Do the number of bottles received agree with the COC? s No N/A <br />Were samples received intact? (i.e. no broken bottles, leaks etc.) 'Yes No <br />Sign and date the COC, obtain LIMS sample numbers, select methods/tests and print labels. <br />Sample Verification, Labeling and Distribution: <br />I. Were all requested analyses understood and acceptable? No <br />Did bottle labels correspond with the client's ID's? No <br />Were all bottles requiring sample preservation properly preserved? Yes No ICA FGL <br />lException: OH &Grease, VOA and CrV1 verified in lab] <br />VOAs checked for Headspace? Yes No <br />Have rush or project due dates been checked and accepted? Yes No <br />Were all analyses within holding times at time of receipt? es No <br />Attach labels to the containers and include a copy of the COC for lab delif. <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 />Person Contacted: Phone Number: <br />Initiated By: Date: <br />Problem: <br />Resolution: <br />Person Contacted: Phone Number: <br />Initiated By: Date: <br />Problem: <br />Resolution: <br />(Please use the back of this sheet for additional comments cm <br />/ / <br />No <br />No <br />e samples. <br />Shipping tracking #(s):57,0 I -Y71 -7 lc) <br />/A <br />(3019150) <br />Mike Wutzke <br />STK2450198 <br />iv 0712412024 16:21:39 <br />MINI
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