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COMPLIANCE INFO_2015-2019
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0539648
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COMPLIANCE INFO_2015-2019
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Entry Properties
Last modified
10/7/2020 1:43:57 PM
Creation date
7/24/2019 11:49:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2015-2019
RECORD_ID
PR0539648
PE
1609
FACILITY_ID
FA0022688
FACILITY_NAME
RUSTIC CRUNCH
STREET_NUMBER
3958
Direction
W
STREET_NAME
SARGENT
STREET_TYPE
RD
City
LODI
Zip
95242
APN
02514003
CURRENT_STATUS
01
SITE_LOCATION
3958 W SARGENT RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
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O <br /> Tri-Annual CHwww..fgUnc comODY <br /> c Laboratory Copy (1 of 3) a <br /> y <br /> 36021:02/05/2018 TEST DFS IPTION - See Reverse side for Container,Preservative and Sampling info ion <br /> Client: Ron Kittle <br /> Address: 3958 West Sergent Road.1 <br /> Lodi,CA 95242 - a <br /> Phone: (209)367-0205 Fax: (209)367-0201 <br /> 3 a <br /> Contact Person: Ron Kittle ; a <br /> Project Name: 3958 W. Sergent Rd 9 <br /> Purchase Order Number: V W d o <br /> _ 3 N <br /> Quote Number. <br /> Sampler(s) ( e <br /> E V C T O <br /> Y <br /> V • � N p p, a,�^ Z Z <br /> Sampling F. ' kup Fee: R a 'Q W EE-� `^ 14= z z <br /> Compositor Setup Dam:_/_/_ Time:_/_ z <br /> E a z O c <br /> n <br /> Lab Number: STK MIEl 3-13723 `o G ii N t:5 8 <br /> Sam Date Time -S - E $ <br /> m LoV <br /> Location Description Sampled Sampled " u u � u <br /> Nu <br /> F n. A C2o u- 3m 3t <br /> I Well G DW I t I <br /> Remarks: Relin uish Date: Time: m had ,Datp;a/7 <br /> Date: Time: <br /> q a/�a�ia «Gv ��, f, <br /> ceiv By: De� Time: Received By: Da e: II Da T�m <br /> °� 'Z�a l'S /'/aa oz/i l� rq <br /> Corporate Offices&Laboratory Office&Laboratory Office&LaboratoryOffice&Laboratory <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Lindo 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chlco,CA 95926 San Luis Obispo,CA 93401 Visalia,CA 93291 <br /> Phone:(805)392-2000 Phone:(209)942-0182 Phone:(530)343-5818 Phone:(805)783-2940 Phone:(559)7349473 <br /> Env Fax:(805)5254172/Ag Fax:(805)392-2063 Fax:(209)942-0423 Fax:(530)343-3807 Fax:(805)783-2912 Fax:(559)734-8435 <br />
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