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COMPLIANCE INFO_1986-2006
Environmental Health - Public
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231331
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COMPLIANCE INFO_1986-2006
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Last modified
6/20/2023 9:32:19 AM
Creation date
6/3/2020 9:43:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1986-2006
RECORD_ID
PR0231331
PE
2351
FACILITY_ID
FA0000513
FACILITY_NAME
LODI MEMORIAL HOSPITAL
STREET_NUMBER
975
Direction
S
STREET_NAME
FAIRMONT
STREET_TYPE
AVE
City
LODI
Zip
95240
APN
03107039
CURRENT_STATUS
01
SITE_LOCATION
975 S FAIRMONT AVE
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2351_PR0231331_975 S FAIRMONT_1986-2006.tif
Tags
EHD - Public
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CASTLE ANALYTICAL LABORATORY CHAIN OF CUSTODY <br />Location: 2333 Shuttle Drive, Bldg 908/909, Atwater, CA 95301 Certificate No. 2480 <br />Mailing Address: 2333 Shuffle Drive, Atwater, CA 95301 PAGE OF <br />t -none: (zuv) 6b4-zu6u - rax: (zuu) jts4-i 5ut <br />Customer: ! < '-,t <br />6 <br />-/e,) jq -,vq A <br />REQUESTED <br />ANALYSES <br />W <br />Method of Shipment: <br />Address: <br />x f; <br />0 <br />N <br />co <br />W <br />W <br />z <br />City/State/ZIP: <br />Notes: -14 x <br />Phone FAX: <br />< S <br />U) <br />10 <br />Z <br />Proj # P.O. <br />W <br />LL <br />W <br />9 W <br />W <br />U) <br />Uj <br />00 <br />0 C) <br />'T <br />0 <br />0 <br />Report Attention: Al <br />/I Tll/'�- <br />0 <br />co co <br />U - <br />0 <br />Sampler Signature.* <br />8 <br />< 'a <br />u) = <br />0 <br />w <br />x <br />w <br />0- <br />a- <br />W <br />W <br />M <br />Printed: <br />511�' z <br />4� <br />co <br />2 <br />Z <br />0 <br />W <br />Labb,#: SAMPLE ID <br />DATE <br />TIME DESCRIPTION/LOCATION <br />OBSERVATIONS/REMARKS <br />1/4 <br />Uldl DUMDW Di writainers suumllteu to <br />Si''ature the laboratory <br />ig Printed Name Date Time Company Name <br />Relinquished by: j <br />Note: All special requests (e.g. <br />Received by:,quick turn times) must be cleared <br />through authorized laboratory <br />Relinquished by: personnel . <br />RESULTS DUE: <br />La VERBAL WRITTEN <br />
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