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6-NAME (S) AND PHONE NUMBER fS) <br />DAY <br />^-7? ~ <^71 ?NIGHT <br />DAY B. <br />NIGHT <br />/ &ROUTINE <br />/REPEAT #1 <br />REPEAT #2 <br />REPEAT #3 <br />REPEAT #4 <br />ROUTINE #2 <br />REPEAT #1 <br />Date REPEAT #2 <br />REPEAT #3 <br />REPEAT #4 <br />8.SUBMITTED BY: <br />SAMPLE SITING PLAN <br />INFORMATION REQUIRED <br />7 <br />V' u/tl fot, <br />3 <br />NO. <br />2. <br />OWNER(S) <br />/C>(oe> <br />jz£> <br />4_ <br />NAME OF CERTIFIED LABORATORY <br />5. ______/ <br />NAME(S) OF SAMPLER(S) IF NOT LABORATORY PERSONNEL <br />' a <br />CONTACT #2 <br />7^0fcpproved_____________________ <br />QApprovnd .-••’th St?© Ramarks <br /> Difiapr c ■ ' a / ------------- <br />Remarks.-...-...-, ..................................... <br />u 1 <br />• W ^7^4 <br />7.ADDRESSES OR LOCATIONS OF ROUTINE AND REPEAT SAMPLE SITES <br />— • Approval of these plans extends only to that <br />—----------------------------------which is ? iovj- and described hereon but <br />— does not authorize or approve any omission <br />----------tdeviation 0! requirements of State laws or <br />Ordinances. <br />■poiAddAS <br />A^t^2_ trrv&A ^E. -TSAhUflAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DIVISION <br />304 E. Weber Ave. Third Floor <br />HO Box 388. Stockton, CA 95201-0388 <br />Phene; (209) 463-3420 <br />1. c <br />NAME OF SYSTEM <br />OF PERSONS LABORATORY ARE TO CONTACT <br />FOLLOWING ANY POSITIVE SAMPLE <br /> <br /> ------ <br /> <br /><t r Jc C (GU €V- <br />. I PA1 <br />OF RESIDENCES OR AVERAGE NO. OF PERSONS SERVED PER MONTH