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ARCHIVED REPORTS_XR0003134
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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3500 - Local Oversight Program
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PR0545307
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ARCHIVED REPORTS_XR0003134
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Entry Properties
Last modified
2/11/2020 9:55:27 PM
Creation date
2/11/2020 9:01:34 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003134
RECORD_ID
PR0545307
PE
3528
FACILITY_ID
FA0000932
FACILITY_NAME
DOMINO'S #8588
STREET_NUMBER
305
Direction
S
STREET_NAME
HUTCHINS
STREET_TYPE
ST
City
LODI
Zip
95240
APN
03319020
CURRENT_STATUS
02
SITE_LOCATION
305 S HUTCHINS ST
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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19M P <br /> A 1117G' VC� HAIN OF CUSTODY RECORD �-�, _ <br /> Analytital Laboratory __ _ Phone (916)362-8947 C.O.C:No. -1-0655 -S_�Dt <br /> 3050 Foe Circie�#112 Sacramento,CA 95827 - —- FAX 916 362-0947 Pae Z - - of Z ---- STAL Invoice Number <br /> Company �Lc0C'C"o Phone �1tb R-S2-- 9I� _ _ - ANALYSIS REQUEST <br /> Protect Manager-`R t c-K W,-u-S =— FAX �"S2.. 91.1 z70,� REMARKS ` � � ' TEk' MT$E Sampler's Name <br /> Report Address Billing Name 8-Address Stt �� [ p •. /�Oa r. /p( <br /> _32-36 <br /> - -- — .5'��aAz�1- TAi <br />_ - `o ' ;^ , c `i 514 � <br /> z All None Some G£-O- <br /> cVIII,3 <br /> Project Name Project/JW OK OK OK WET STLC - <br /> 105- .5 fly, h/i►n, _ - - 5 �0�'U-- Qd 03 Cooler Temp °C <br /> Project Locaiion "� = P�# " _ _ Sample Condition - - -"TCLA <br /> Y <o4I, C-A - - - pH _ 5 <br /> G <br /> ` Preservative TCLP Total <br /> Sampling Container Used Matrix _ TAT <br /> co y� N <br /> i <br /> C <br /> 117 y O Y _ N <br /> p p Ln mCO <br /> Z <br /> r <br /> a � <br /> Q! CL UCq <br /> 117 <n t N <br /> m 0 w E 0 [[ a a CJ � 0 <br /> m `o 0' No o f_o 0 0 0 -o of <br /> QI s w M a O7 o <br /> EL <br /> CIDm O 6 O O N N O <br /> Ey Ca m I m in m X v m _.� w /0 0 cn a c <br /> A <br /> o r e — s u3 w = Q ' ¢ �t ¢ Q Q ro e `° e t a <br /> co <br /> NO SAMPLE ID Date Time m` N Q U I z o c°n C o m w ( w w u�i uai w z° o c¢3 cos a = <br /> AA l31D 4 X x y - - <br /> x <br /> 2 ESB -! iso p Z <br /> 3 X <br /> I X , <br /> 4 - - - <br /> S_ <br /> II 10 - - - - - - - - - --_- - - - - <br /> ReIE guishe by = = Received by - -- Reii h1eAbv <br /> Date/ /2k( ( IT Time 40t) Date !i 4S Time 1G-1D Date i 4 1 S` �a me 1 t�Sr Date 1 J �t - Time <br /> Ti <br /> PLEASE READ REVERSE SIDE FOR TERMS AND CONDITIONS - - - - - - - <br />
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