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ARCHIVED REPORTS_XR0002636
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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H
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HARLAN
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15600
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3500 - Local Oversight Program
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PR0545273
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ARCHIVED REPORTS_XR0002636
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Entry Properties
Last modified
2/3/2020 6:57:37 PM
Creation date
2/3/2020 11:28:09 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0002636
RECORD_ID
PR0545273
PE
3528
FACILITY_ID
FA0000174
FACILITY_NAME
JOES TRAVEL PLAZA
STREET_NUMBER
15600
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19620079
CURRENT_STATUS
02
SITE_LOCATION
15600 S HARLAN RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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CASTLE ANALYTICAL LABORATORY CHAIN OF CUSTODY <br /> Location Castle Air Park, Bldg 909, Atwater, CA 95301 Certificate No 2079 <br /> Mailing Address P 0 Box 1360, Winton, CA 95388 PAGE__/_OF_L_ <br /> f Phone (209) 384-2930 - Fax (209) 384-1507 <br /> r <br /> Customer <br /> $1l..4f /k& G /L REQUESTED ANALYSES Method of Shipment <br /> + Address {gyp �p 13(oUAp,� <br /> j City/State/ZIP (�} / 3 i �' x_ _ W <br /> 1t Wag o ar <br /> NojteJ}s <br /> j3wPhone / FAX <br /> Pro) # IPU # a -j w O I� s 7 o 0 <br /> =- zReport Attention 2QaLL <br /> �S <br /> w a 0 { <br /> Sampler Signature a 3 �' m ~ F- '� cc <br /> m 2 q JV' <br /> Printed q <br /> � i Z <br /> I - <br /> , <br /> Lab ID# SAMPLE ID DATE TIME DESCRIPTIONILOCATION OBSERVATIONS/REMARKS <br /> - g — 1d i l fel-yc� S <br /> I; <br /> i <br /> I _ <br /> t <br /> i <br /> Total number o ntainers submitted to <br /> i n tore Printed Name Date Time Company Name the Iabo <br /> ftm <br /> Relinquished by J Ilo Note All special requests(e g quick <br /> tum times)must be cleared through <br /> Received by authorized laboratory personnel <br /> i, Relinquished by <br /> Received by <br /> Relinquished by RESULTS DUE <br /> Recelved by C [�L' �/lv 17 LVERBAL WRITTEN <br />
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