HomeMy WebLinkAbout039-230-109 EH-WR-26-0003 WELL SAMPLING DATAJanuary 27, 2026
Michelle Hodge
9681 Midway
Durham, CA 95938
Coliform Bacteria Analysis
Lab No.: CH 2670716 1
Customer No.: 7014696
System Number: N/A
Project Name : 9681 Midway
Analytical Results
ID Sample Description Total Fecal E. Coli Units Method Prep Footnote
1 Bathroom Sink Absent ---Absent A/P/100ml SM 9223B Colilert-P/A 18
N/R Not Required MPN Most Probable Number A/P Absence/Presence
Result Interpretation
The samples listed above were Acceptable for both Total and Fecal Coliform
Sample Handling Information
ID Sample Number System Number Sample Type/Reason Sampler Employed By Sampled
1 CH 2670716-001 N/A System-Other Daniel Hodge Michelle Hodge 2026-01-23 13:58
Field Analysis/QA Information
ID Sample Description Cl Total/Free Temp Analysis Started Analysis Completed Contact Contacted
mg/l
1 Bathroom Sink ---/------2026-01-23 16:41 kx1 2026-01-24 12:17 zmp N/R
Analyses were performed at the FGL Chico Laboratory using Standard Methods 20th edition. If you have any questions regarding your
results, please call.
Prepared By: RRH
Page 1 of 1
Corporate Offices & Laboratory853 Corporation StreetSanta Paula, CA 93060TEL: (805)392-2000CA ELAP Certification No. 1573
Office & Laboratory2500 Stagecoach RoadStockton, CA 95215 TEL: (209)942-0182 CA ELAP Certification No. 1563
Office & Laboratory
563 E. Lindo AvenueChico, CA 95926TEL: (530)343-5818
CA ELAP Certification No. 2670
Office & Laboratory9411 W. Goshen Avenue Visalia, CA 93291
TEL: (559)734-9473CA ELAP Certification No. 2810
Office & Laboratory
3442 Empresa Drive, Suite D San Luis Obispo, CA 93401 TEL: (805)783-2940
CA ELAP Certification No. 2775
ENVIRONMENTAL AGRICULTURAL
Analytical Chemists
Reviewed and
Approved By Raquel R. Harvey Digitally signed by Raquel R. HarveyTitle: Tech Director MicrobiologyDate: 2026-01-27
[::nviROhMr>r]TAL agricultui^Iv
AiuiiyliGil Cliciiiist.s
www.fglinc. com
CHAIN OF CUSTODY
AND ANALYSIS REQUEST DOCUMENT
ciient:/\/V'ichelleJfiocJae lyxra/"
Customer Number:
Address:
/^i6.\voJi 0(/rJ»a.fn CA
Phone:
Email
Contact Person:'
Project Name:
Purchase Order Number:
Quote Number:
Rush Analysis: | | 5 Day | | 4 Day | 13 Day| | 2 Day | | 24 hour
Rush pre-approval by lab (initals):
Electronic Data Transfer: □ No □ State I Iciient Otlier:
Sampler(s):
Sampling Fee:
Compositor Setup Date:
Lab Number:
oc.imu.
Pickup Fee:
Time:
aE
Samp
Num
Location Description Date
Sdmpled
Time
Sampled
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39&(L
TEST DESCRIPTION AND ANALYSES REQUESTED
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Remarks Relinaujshed
Received By: ^«ate: , i ime:Ell il^h'mate: , Time:
RelinquisI /Date- Time:
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Received By: I Date: Time:' hs he j
Relinquished Date:Time:
2 N I iQ.'AEl^r, \9S\
Received Date: Time:
\IViHa. 17/^
xboratory / ^ Offleo A LaboratoryOffice A Laboratory
9411 WCorporate Offieos & Laboratory
853 Corporation Street
Santa Paula, CA 93060TEL: (805)392-2000
Env FAX: (805)525-4172
CA ELAP Certification No. 1573
Offiee & Laboratory
2500 Stagecoach Road
Stockton, CA 95215TEL: (209)942-0182
FAX: (209)942-0423
CA ELAP Certification No. 1563
Office & Laboratory
563 E. Lindo Avenue
Chico.CA 95926
TEL: (530)343-5818FAX: (530)343-3807
CA ELAP Certification No. 2670
Office & Laboratory
3442 Empresa Drive, Suite DSan Luis Obispo, CA 93401
TEL: (805)783-2940
FAX: (805)783-2912
CA ELAP Certification No. 2775
. Goshen Avenue
Visalia, CA 93291
TEL: (559)734-9473FAX: (559)734-8435
CA ELAP Certification No. 2810
FGL Environmental /O / "j a _ Doc ID: Inter lab CUR.docRevision Date: 10/10/23 (j) f ^ j j ^ Page 1 of 1
Inter-Laboratory Condition Upon Receipt (Attach to COC)Saniple Receipt at:
CO CSB> STK VI
1. Number of ice chests/packages received: Shipping tracking #(s):
2. Temp IR Gun ID #: ^ J ^
3. Were samples received on ice? No Temps: I (. // I I I
Surface water SWTR bact samples: A sample that has a temperature upon receipt of >10° C, whether iced or not,
should be flagged unless the time since sample collection has been less than two hours.
4. Do the number of bottles received agree with the COG?
5. Were samples received intact? (i.e. no broken bottles, leaks etc.)
6. VOAs checked for Headspace?
7. Were all analyses within holding times at time of receipt?
8. Verify sample date, time and sampler name
Sign and date the COG, place in a ziplock and put in the. same ice chest as tKe^amples.
Sample Receipt Review completed by (initials): tloH
Sample Receipt at SP: . . ^ in iO
1. Number of ice chests/packages received: 1 Shipping tracking #(sVr9 HI 1 j o T M- i
2. Temp IR Gun ID #: \ q
3. Were samples received on ice? No Temps: / / / /
Acceptable is above freezing to 6°C. If many packages are received at one time check for tests/H.T.'s/rushes/
4. Do the number of bottles received agree with the GOG? No N/A
5. Were samples received intact? (i.e. no broken bottles, leaks etc.) Yes No
Sign and date the GOG, obtain LIMS sample numbers, select methods/tests and print labels.
Sample Verification, Labeling and Distribution:
1. Were all requested analyses understood and acceptable?
2. Did bottle labels correspond with the client's ID's?
3. Were all bottles requiring sample preservation properly preserved? ^s No N/A FGL
(Exception: Oil & Grease, VOA and CrVI verified in lab]
4. VOAs checked for Headspace? Yes No
5. Have rush or project due dates been checked and accepted? Yes No
6. Were all analyses within holding times at time of receipt? (^s No
Attach labels to the containers and include a copy of the GOG foUab delivery.
Sample Receipt, Login and Verification completed by (initials): (
Discrepancy Documentation:
Any items above which are "No" or do not meet specifications (i.e. temps) must be resolved.
1. Person Gontacted: Phone Number:
Initiated By: Date:
Problem:
Resolution:
Person Gontacted: Phone Number:
Initiated By: (7014696)
Problem:
Resolution:
(Please use the back of this sheet for additional comments or con