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ARCHIVED REPORTS_XR0008839
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_XR0008839
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Entry Properties
Last modified
11/19/2024 3:45:50 PM
Creation date
6/3/2020 11:28:32 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008839
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
Scanner
LSauers
Tags
EHD - Public
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i i i i � i i i � � f� � i f� f� f• � � f� <br /> � <br /> CHAIN OF CUSTODACORD <br /> Advanced <br /> GeoEnvironmental, Inc Date -1-oPage at <br /> 837 Shaw Road Stockton California- 95215- (209)467-1006 - Fax (209) 467-1118 1 0 <br /> Client L <br /> Project Manager � <br /> � ti � s `I lr Jl � Tests Required <br /> Phone Number <br /> 2oq- q rI - Lur--�cc <br /> Sa rs (Signature) �Lj� Invoice <br /> •�— Q� AG E <br /> Project Name 1 ; Pl4.POS r - Client ❑ <br /> Sample Type AUT <br /> Sample Location Date Time Water Solid No of �� Notes <br /> Number Description Comp Grab Air Conts fa h Lj /V <br /> Poo <br /> 64N1 - �� �l tr I L l5 ��`� x, 1 <br /> AW 1- 20 (� t+ 1 � 20 � 1 � �, 1 <br /> kW[ 6 Z5- °I2t7 1 ` <br /> �nw 2 - 5 ,f t► 2 � 5 135 � � �o�� <br /> if I( 2 eft) loLto Or <br /> ein s ed � ecerve y ignature U`a�telTrme <br /> R tinquished by (Signature) Received by (Signature) Datefrome <br /> TAT <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTrme <br /> Dispatched by (Signature) Date(Trme Received for Laboratory b Date/Tome <br /> - If_ a 9' <br /> Method of Shipment t Lobo ory Name �� <br /> Special Instructions I hereby authorize the performance of the above indicated work <br />
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