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SR0084582_SSNL
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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BRUELLA
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23702
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2600 - Land Use Program
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SR0084582_SSNL
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Entry Properties
Last modified
12/14/2021 4:56:28 PM
Creation date
12/14/2021 4:50:12 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2600 - Land Use Program
FileName_PostFix
SSNL
RECORD_ID
SR0084582
PE
2602
STREET_NUMBER
23702
Direction
N
STREET_NAME
BRUELLA
STREET_TYPE
RD
City
ACAMPO
Zip
95220
APN
C
ENTERED_DATE
12/7/2021 12:00:00 AM
SITE_LOCATION
23702 N BRUELLA RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
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SJGOV\tsok
Tags
EHD - Public
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�- ENVIRONMENTAL <br />Lab Number: <br />14/55 /5a <br />Creno Live Oak GeoEnvironmental <br />Customer Number: 3016608 l <br />Address: 407 W Oak St <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />TEST DESCRIPTION AND ANALYNtb KLYUEJ I CU <br />Lodi, CA 96240 <br />Ia�Iq%21' 1I S'O <br />G 4 `P/G P DW SRC X O <br />X. .. <br />- <br />,. <br />} . <br />L - <br />-- <br />Phone: (209) 369-0375 Fax: <br />t I <br />• <br />: <br />i <br />I <br />>. <br />f 1 <br />t <br />Email Address: abby@logelodi.com <br />Relinquished Date: Time: I Rel�u+c�d <br />�� /Yl 7..1 / 1, , _ /t l <br />D te: Time: I Rel' 'shed ed Date: Time: <br />fol _ / . 1 �� A..I <br />Contact person: Abby Racco <br />s <br />_ <br />Project Name: Clarke, 23702 N. Bruella Rd., Acampo n <br />- <br />Purchase Order Number: <br />j <br />i <br />4 <br />O <br />Quote Number. <br />o <br />5 <br />a. <br />o <br />ZE <br />Sampler(s): <br />l <br />F <br />O�. <br />Fee: <br />N <br />Sampling Fee: Pickup <br />Time: <br />-� <br />Z <br />Compositor Setup Date: <br />Samp <br />Location Description <br />I <br />DateTime <br />( <br />m <br />Y i <br />i <br />Num <br />Sampled <br />Sempted <br />.--I <br />0 Travel Blank jo qhi 1215D <br />G <br />2 <br />G <br />1 Domestic Well <br />Ia�Iq%21' 1I S'O <br />G 4 `P/G P DW SRC X O <br />X. .. <br />- <br />,. <br />} . <br />L - <br />-- <br />t I <br />• <br />: <br />i <br />I <br />>. <br />f 1 <br />t <br />iRemarks <br />I <br />Relinquished Date: Time: I Rel�u+c�d <br />�� /Yl 7..1 / 1, , _ /t l <br />D te: Time: I Rel' 'shed ed Date: Time: <br />fol _ / . 1 �� A..I <br />Corporate Offices & Laboratory <br />853 Corporation Street <br />Santa Paula. CA 93060 <br />TEL: 805/392-2000 <br />FAX: 8051525.4172 <br />CA NELAP Certification No. 01110CA <br />By: Date: Time: <br />Received By: <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: 2091942.0182 <br />FAX: 209/542-0423 <br />CA ELAP Certification No. 1563 <br />UGte: Time: <br />°d �9�iai, r7c <br />Office & Laboratory <br />563 E. Llndo Avenue <br />Chico, CA 95926 <br />TEL: 530/343.5818 <br />FAX: 530/343-3807 <br />CA ELAP Certification No. 2670 <br />By: te: 1 Time: <br />D MD-- <br />Field Office <br />Visalia, California <br />TEL: 559/734.9473 <br />Moble: 559/737-2399 <br />FAX: 559f7344435 <br />
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