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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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5154
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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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r-011 C_1 r-"4 l`'? r- T r1'1 roll r-r r-? <br /> � 5 <br /> CASTLE ANALYTICAL LABORATORY 9803000325 CASTLE_ANALY USTODY <br /> -Location:-2333Shuttle Drive, Bldg 908/909, Atwater, CA.95301 .. Certific;. <br /> Maumg Address: 2333 Shuttle Drive, Atwater, CA 95301 _OF__/_ <br /> Phone: 12091384-2930 - Fax: 12091384-1507 <br /> Customer: ( REQUESTED ANALYSES Method of Shi went: <br /> Address: tLAO v / <br /> City/State/ZIP: D m„ m a Notes: <br /> Phone I FAX: 0/ C) w a a w y o <br /> Proj # / P.O. #: v s El LL <br /> Report Attention: LG S w u < a w a � °� <br /> Sampler Signature: g u H m ~ ~ u <br /> m <br /> Printed: N i <br /> Lab to# SAMPLE ID DATE TIME DESCRIPTION/LOCATION. OBSERVATIONS/REMARKS <br /> Total number of containers submitted to <br /> Signature Printed Name Date Time Company Name the laboratory <br /> Relinquished C 1 "-�� Gr' Note:All special requests(e.g.quick <br /> turn times)must be cleared through <br /> Received b .- authorized laboratory personnel. <br /> Relinquished by: <br /> Received by: <br /> Relinquished by RESULTS DUE <br /> 4 P Received by: -S ' k2sc VERBAL JWRTTEN <br />
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