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WP0041894
EnvironmentalHealth
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041894
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Entry Properties
Last modified
12/21/2021 3:04:33 PM
Creation date
12/21/2021 3:03:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041894
PE
4380
STREET_NUMBER
5823
STREET_NAME
FAIRLANE
STREET_TYPE
RD
City
ACAMPO
Zip
95220-
APN
00527015
ENTERED_DATE
4/2/2021 12:00:00 AM
SITE_LOCATION
5823 FAIRLANE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2021
Tags
EHD - Public
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Special CHMN OF CUSTODY <br />P www.fgUfnc.com <br />t € Field Copy 0 of 3) <br />3-573 8/02/2021 <br />ENVIRONMENTAL = AGRICULTURAL <br />Analytical Chemists <br />Office & Laboratory <br />853 Corporation Street <br />_Office <br />2500 Stagecoach Road <br />Special CHMN OF CUSTODY <br />P www.fgUfnc.com <br />t € Field Copy 0 of 3) <br />Corporate Offices & Laboratory <br />3-573 8/02/2021 <br />TEST DESCRIPTION See Reverse side f« Conta , r. Prr enatice and Sampling information <br />Client: San Joaquin County EHD <br />Office & Laboratory <br />853 Corporation Street <br />_Office <br />2500 Stagecoach Road <br />563 E. Lindo <br />3442 Empresa Drive, Suite D <br />9415 W. Goshen Avenue <br />Santa Paula, CA 93060 <br />Stockton, CA 95215 <br />Chico, CA 95926 <br />San Luis Obispo, CA 93401 <br />Visalia, CA 93291 <br />Phone: (805) 392-2000 <br />Phone: (209) 942-0182 <br />Phone: (530) 343-5818 <br />Address: San Joaquin Co. Environmental Health Dep <br />Phone: (559) 734-9473 <br />Env Fax: (805) 525-4172 / Ag Fax: (805) 392-2063 <br />Fax: (209) 942-0423 <br />Fax: (530) 343-3807 <br />Fax: (805) 783-2912 <br />Fax: (559) 734-8435 <br />Water Quality Division <br />? <br />a <br />Atm: Michael Kith <br />3 <br />18f8 East Hazelton Ave. <br />Stockton, CA 95205 <br />a <br />Phone: (209)468-3444 Fax: <br />ua <br />y <br />a <br />Contact Person: Michael Kith <br />A d <br />R <br />Project Name: <br />Purchase Order Number: r ;':, t o <br />> <br />a <br />0 <br />Quote Number: <br />N <br />W ¢ <br />a <br />z <br />`6 <br />> <br />p <br />U <br />A <br />Sampler(s) <br />` <br />O <br />.� 0 <br />o <br />Sampling Fee: Pickup Fee: <br />�o <br />Compositor Setup Date: _/_/_ Time: /_ <br />p z <br />O, <br />O <br />w <br />Lab Number: STK 3-17919 <br />0 <br />0 <br />p <br />0 Z <br />a <br />F <br />P4 � <br />0 C7 <br />Samp <br />Location Description <br />Date <br />Sampled <br />Time <br />Sampled <br />5 <br />F <br />'t <br />M <br />p <br />V) <br />Num <br />ate. <br />pq <br />1 <br />G <br />DW <br />Sub -3 <br />Remarks: <br />Relinquished Date: Time: Relinquished Date: Time: Relinquished Date: Time: <br />Received By: Date: Time: <br />Received By: Date: Time: <br />Received By: Date: Time: <br />Corporate Offices & Laboratory <br />& Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />Office & Laboratory <br />853 Corporation Street <br />_Office <br />2500 Stagecoach Road <br />563 E. Lindo <br />3442 Empresa Drive, Suite D <br />9415 W. Goshen Avenue <br />Santa Paula, CA 93060 <br />Stockton, CA 95215 <br />Chico, CA 95926 <br />San Luis Obispo, CA 93401 <br />Visalia, CA 93291 <br />Phone: (805) 392-2000 <br />Phone: (209) 942-0182 <br />Phone: (530) 343-5818 <br />Phone: (805) 783-2940 <br />Phone: (559) 734-9473 <br />Env Fax: (805) 525-4172 / Ag Fax: (805) 392-2063 <br />Fax: (209) 942-0423 <br />Fax: (530) 343-3807 <br />Fax: (805) 783-2912 <br />Fax: (559) 734-8435 <br />
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