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COMPLIANCE INFO_2015-2019
EnvironmentalHealth
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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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FM f CHMN of CUSTODY <br /> Quarterly www.fgUnc.com <br /> Laboratory Copy (1 of 3) <br /> 1111111 36021:05/07/2018 TEST DESCRIPTION Sec Renese side linCumuiner, preen aline and Sampling inlirtmatiun <br /> Client: Ron Nlltle <br /> Address: 3958 West Sergent Road <br /> Lodi,CA 95242 „a <br /> Phone: (209)367-0205 Fax: (209)367-0201 3 <br /> 0 <br /> Contact Person: Ron Hiule y <br /> Project Name: 3958 W. Sergent Rd 'E o <br /> Purchase Order Number: U W ,a`2 'o � <br /> V, ry V <br /> Quote Number: U w 3 y <br /> Q 5 a <br /> Sampler(s) x E <br /> g w i u <br /> Z <br /> 5 C 6 TO <br /> Sampling Fee: O r4ickup Fee: e 0 <br /> Compositor Setup Date: I / Time: / E ++ Z ms .c <br /> Lab Number: STK 3-13723 o w <br /> Samp '=Date Time 5 �' ny '_ v ._ E <br /> Num Location Description Sampled Sampled F a 120 u <br /> 1 Well �- .)8 G DW I <br /> Remarks: 'nquished Date: Time: Relinquished Date: Time: Relinquished Dale: Time: <br /> 318 M5 <br /> Received By: ate: Time: Received By: Date: Time: Received By: Date: Time: <br /> 55 13 -5 <br /> 31 <br /> Corporate Offices&Laboratory Office&Laboratory Office&Laboratory OHlee A Laboratory Office8 Laboratory <br /> 853 Corporation Street 2500 Stagecoach Road 563 E.Undo 3442 Empresa Drive,Suite D 9415 W.Goshen Avenue <br /> Santa Paula,CA 93060 Stockton,CA 95215 Chico,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:(BD5)5254172/Ag Fax:(805)392-2063 Fax:(209)942-0423 Fax:(530)3433807 Fax:(805)783-2912 Fax:(559)734-8435 <br />
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