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COMPLIANCE INFO_2022
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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ELLIOTT
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23216
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1600 - Food Program
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PR0546753
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COMPLIANCE INFO_2022
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Entry Properties
Last modified
6/23/2022 1:57:52 PM
Creation date
6/23/2022 1:55:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2022
RECORD_ID
PR0546753
PE
1608
FACILITY_ID
FA0026501
FACILITY_NAME
ELLIOTT ROAD BARN
STREET_NUMBER
23216
Direction
N
STREET_NAME
ELLIOTT
STREET_TYPE
RD
City
ACAMPO
Zip
95220
CURRENT_STATUS
01
SITE_LOCATION
23216 N ELLIOTT RD
QC Status
Approved
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SJGOV\jcastaneda
Tags
EHD - Public
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www.fglinc.com <br />CHAIN OF CUSTODY <br />AND ANALYSIS REQUEST DOCUMENT <br />Ctimc Julie Edsell <br />Lab Number: <br />TEST <br />DESCRIPTION <br />AND <br />ANALYSES <br />REQUESTED <br />Cmtumer Number: 3018723 <br />Addreer: 23216 N. Elliott Rd , <br />——:,cemDo-GA�JSE20-- <br />Phene: (209)663.8429 Fm: <br />EmnaAd6-,: iedsellflfiftmail.00m <br />c—I Pmon: Julie Edsell .,.#- s K�nj I <br />Project Noma1� %3o2l ?1)4,WD, 6GI . <br />Pechme Orda N.bm: <br />= <br />Qmek Number. <br />� <br />C3 <br />8 <br />Ruth Analyse: E]SDry❑<Day ❑3Duy[–]2Day24 hour <br />�g <br />$PA <br />O <br />� <br />'j <br />Rmh pro-gryrovd M bb (mieb): <br />Fhcnimtr Dere Trma(er: E] No Els— OCSenr Oth, <br />{;, <br />pp <br />O <br />y <br />1Z$8P <br />� <br />� <br />a <br />� <br />^ap <br />�Qe a <br />Swpla(c):� <br />/ / <br />2 <br />Swpling Fee: Pirkep Fac <br />0 <br />p <br />17 <br />1 <br />poahorS C. Time. <br />m <br />05 <br />nLocaP tion DescrOjon Date <br />Num Sampled <br />Sampled <br />n <br />G I <br />errretkt <br />oohed Dar. Tine Relmq " <br />'C <br />ed Da Time: <br />Rol Relmgviehed D..: Tine: <br />Al <br />f I <br />fteee^'ed e: T®e. <br />Reeemed 11A Dae: T' <br />Received By: Dme: T®c: <br />' <br />Qmrpmrafe 018eee 3 Lebormpe <br />653 Coryonftn Street ry 016oe 8 Laboramlm <br />tory 08fee 6 LabW y ORtee 6 Labmraw <br />Same ry OlBee 8laboramry <br />2600 Stagecoach Road 563 E DndoAmme 3415 W.Ooahen Awv w <br />-2 Stock . CA 85215 CNm CA 96926 , Soya D <br />TEL (8005)76)362.2000 83050 7442 Empresa Orlve <br />TEL: (209)942.0182 Oen I(00 )78322 40 33401 TEUV1341(5 9) 33291 <br />Fnv FAX: (806)526-4172 /AD FAx (806)392-2053 FAX: (288)842,0423 TEL' (530),3035318 TEL: (306)7332810 TEL' (669)770.3973 <br />CA ELAS CA ELAP <br />Cer00eaWn No.1673 FAX, (630)3033807 FAX: (805)7332812 FAX: (558)730.8436 <br />CMglratle No.1fiW d'CeBKlceS Nm 2870 ._SFr eo rerOfNa9on No. 2776 __ CA ELAP Ce01raa0ogN9. T310 ... ._ <br />
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