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ARCHIVED REPORTS_XR0008833
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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T
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12 (STATE ROUTE 12)
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13889
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3500 - Local Oversight Program
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PR0545719
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ARCHIVED REPORTS_XR0008833
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Entry Properties
Last modified
11/19/2024 3:45:50 PM
Creation date
6/3/2020 11:27:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008833
RECORD_ID
PR0545719
PE
3528
FACILITY_ID
FA0005335
FACILITY_NAME
CHARLES JACOBS
STREET_NUMBER
13889
Direction
W
STREET_NAME
STATE ROUTE 12
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
13889 W HWY 12
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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LSauers
Tags
EHD - Public
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CHAIN OF CUSTODOECORD <br /> Advanced Date �- --- <br /> '- GeoEnvironmental, Inc. <br /> 837 Shaw Fload-Stockton, California-95215-(209)467-1006- Fax (209)467-1118 <br /> Client (� cL �U� P� �mana�e �A Tests Required <br /> hone NWbellr ,, <br /> C)") `-,(U�! Coo Ce <br /> Samplers Signet e) Invoice <br /> AGE <br /> Project Name � � 'Ln� � Client ❑ <br /> Sample Type No of <br /> Sample Location pie Time Water Salld �N Notes <br /> Number DescriptionDate <br /> Grab Air Corns <br /> r <br /> 2 CN3 <br /> .Aw3 <br /> isheign re) starve y (signature) Dater ime <br /> DatelTime <br /> Relinquished by (Signature) Received by (Signature) <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analyars (Signature) Date(Trma <br /> Dispatched by (Signature) Date/Time Received for Laboratory by Date/Time <br /> � Method of Shipment �r �t'[�.f`i�i . Labafatr4INarne <br /> Special instructions V'� � 1 i hereby authorize the erforrnance of the above indicated work <br />
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