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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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• F CUSTOD�CORD <br /> ( Advanced CHAIN O <br /> GeoEnvironmental, Inc Date - -o Page ��� <br /> 837 Shaw Road- Stockton California- 95215- (209) 467-1006 - Fax (209)467-1118 <br /> Client �z� �� ,�$ Project Manager Trf CL4 Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name —TZ;� VLc1QS Y gogl � (4Q52 AGE <br /> Cllertt ❑ <br /> Sample Type <br /> Sample Location Date Time Water Solid No of *� ' Notes <br /> Number Description Comp Grab Air Conts <br /> I <br /> 1-2,o5- X <br /> tc u Q 1 Lt 35 Kvl <br /> �(1r1W LI -- I Ic t( LE <br /> ►Aw q --1 S t( i f is <br /> ' 5 <br /> Ic I w L4 e— 26 J K 5© <br /> AVVLi --Z It t S� IL4 sS - <br /> elinquis a ( _uanature eceive y ignature Date/Time <br /> Rehnqurs d by (Signature) Received by (Signature) DelelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Datelrime <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by /'� Y Datef ime <br /> aims <br /> T <br /> Method of Shipment Laborato� <br /> bit <br /> I hereby authorize the performance of the above Indicated work <br /> Special Instructions <br /> I <br />
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