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ARCHIVED REPORTS XR0003996
Environmental Health - Public
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EHD Program Facility Records by Street Name
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L
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LODI
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204
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3500 - Local Oversight Program
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PR0544962
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ARCHIVED REPORTS XR0003996
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Entry Properties
Last modified
11/6/2019 10:08:44 AM
Creation date
11/6/2019 9:52:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003996
RECORD_ID
PR0544962
PE
3528
FACILITY_ID
FA0003651
FACILITY_NAME
ARTS & ARTISTS
STREET_NUMBER
204
Direction
E
STREET_NAME
LODI
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
04719102
CURRENT_STATUS
02
SITE_LOCATION
204 E LODI AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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� Advanced <br /> CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date 3� �-4$ Page _1— of <br /> r" of Nonhern California <br /> 9803 West March Lane,Suite A Stockton, California-95207-(209)956-0264-Fax(209)9560700 <br /> ClieniProject Manager <br /> f"I 5 !1/ K t v i n M c K 1 kb eh Tests Required <br /> Phone Number <br /> (701)Q56`01(q <br /> Samplers (Signature) Invoice <br /> Project Name A .T r1 i 515 ' � � �� AGE <br /> Client ❑ <br /> Sample Type o- <br /> Sample Location Date Time 5oltd N0 of �"�r Notes <br /> Number' Description ComWater p Grab Air Conts t <br /> Bq- 45 -/�- <br /> $ q - 5' 0 <br /> Bq - 5! I `� <br /> 610 -60 -5 <br /> Bio- 5 � y X - � <br /> Relinquished y (Signature) eceive by -(Tl g 5 a t U r C) AetelT+me <br /> 5701,4dd Vd T.A. . 3-1 -q6 X6. 0 <br /> Ret+nquished by (Signature) Receiveyf b ignature) Dime <br /> Relinquished by (Signature) Received by Mobile Laborato For field analysis (Signature) baterrime <br /> Dispatched by (Signature) Date/Time Received for Laboratory by DatefT+me <br /> Method of Shipment Laboratory Name <br /> Spec I Instruction / I hereby authorize the performance of the above indicated work <br />
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