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SITE HISTORY
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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CENTRAL
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1230
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3500 - Local Oversight Program
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PR0544197
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SITE HISTORY
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Entry Properties
Last modified
2/27/2019 4:07:19 PM
Creation date
2/27/2019 2:20:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE HISTORY
RECORD_ID
PR0544197
PE
3528
FACILITY_ID
FA0005430
FACILITY_NAME
LODI ACADEMY
STREET_NUMBER
1230
Direction
S
STREET_NAME
CENTRAL
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
04728001
CURRENT_STATUS
02
SITE_LOCATION
1230 S CENTRAL AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
WNg
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EHD - Public
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California Water Labs Or <br /> P.0.BOX 4249 Client <br /> 1430 CARPENTER LANE FILE <br /> Address �3/ � f � � � l /1 <br /> PHOONEDESTO(09)274050 COPY Phone No. S� � — 9 f 3 <br /> Contact Person SC <br /> CHAIN OF CUSTODY RECORD (please print) <br /> PROJECT NAME: 7L, <br /> D <br /> SAMPLERS (signatu e) Number <br /> of `� S `� . REMARKS <br /> Station �L ,C (�� v�� �V <br /> Number Date Time U Station Location taCn�rs <br /> r.� G C_Eti•r f2iJ 4 -(c a p <br /> Lq <br /> i <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by(signature): Date ' Time Received by (signature): <br /> Company or Agency: Company or Agency: Company or Agenc : lCompany or Agency: <br /> �i <br /> Relinquished by(signature): Date / Time Received by (signature): Relinquished by: Date / Time Received by (signature): <br /> Company or Agency: I <br /> Company or Agency; Company or Agency: Company or Agency: <br /> RelinquishedJbb signatures Time Received for Laboratory by: Date / Time Remarks/Shipping Information <br /> Copa y or Agency; (/signature) <br /> ' L��( <br />
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