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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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3500 - Local Oversight Program
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PR0545283
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Last modified
2/3/2020 12:27:32 PM
Creation date
2/3/2020 11:38:30 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545283
PE
3528
FACILITY_ID
FA0004712
FACILITY_NAME
WILLIAM BURKHARDT
STREET_NUMBER
5154
STREET_NAME
HOGAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06112001
CURRENT_STATUS
02
SITE_LOCATION
5154 HOGAN LN
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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["'o' r--T t'T Q"I 11 C`^f 1�! Q-'1 c �"T C"'s t ["Z t <br /> CASTLE ANALYTICAL LABORATORY I�(�9 � Xalq� 3�q JV�AIN OF CUSTODY <br /> - .Location: 2333.Shuttle Drive. Bldg 908/909, Atwater, CA 95301 -Certificate No.2079 -. <br /> Mating Address: 2333 Shuttle Drive, Atwater, CA 95301 PAGE__, OF <br /> Phone: (209) 384-2930 - Fax: 1209) 384-1507 <br /> Customer: ? y / ��r •,r REQUESTED ANALYSES Method of Shipment: <br /> Address: UC�7� lu/ /U v y1 G'17�/o/t /�/� <br /> City/State/ZIP: ,: �tyc�..J /"FYI, �' S D — a : C-mllef— <br /> „` - N Notes <br /> Phone / FAX: Z <br /> o ai r�47+d . <br /> Proj # / P.O. #: T2s: I�i2G/ v v a ro o <br /> Report Attention: //Y _y /ML w o W a a o <br /> y o F F K <br /> Sampler Signature: E <br /> Printed: < a <br /> z <br /> Lab ID# SAMPLE ID DATE TIME DESCRIPTION/LOCATION ix5 OBSERVATIONS/REMARKS +/ <br /> �S : Zv <br /> 86767 <br /> 86768 <br /> I ; <br /> I <br /> VOAS I ON I MLIALS1 OTHER <br /> auGu CriNDIT10 <br /> CF. Ji <br /> �t Total number of containers submitted to <br /> ture Printed Name Date Time / Company Name /� the laboratory <br /> Relinquished by: r 2 1 - - ;G�,' G A))I- L Note:All special requests(e.g-quick <br /> Received by: KG y• 2:ee(� 313 �; turn times)must be cleared through <br /> authorized laboratory personnel <br /> Relinquished <br /> Received by: <br /> Relinquished by: RESULTS DUE: <br /> Received by: _j VERBAL j WRITTEN <br />
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