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WP0042920
Environmental Health - Public
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4200/4300 - Liquid Waste/Water Well Permits
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WP0042920
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Entry Properties
Last modified
10/24/2022 3:04:13 PM
Creation date
10/24/2022 3:00:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0042920
PE
4378
STREET_NUMBER
16820
Direction
N
STREET_NAME
LOCUST TREE
STREET_TYPE
RD
City
LODI
Zip
95240-
APN
05112092
ENTERED_DATE
1/19/2022 12:00:00 AM
SITE_LOCATION
16820 N LOCUST TREE RD
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\tsok
Supplemental fields
CYEAR
2022
Tags
EHD - Public
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FGL <br />ENVIRONMENTAL — AGRICULTURAL <br />Analytical Chemists <br />Special <br />CHAIN OF CUSTODY <br />www.fgUnc.com <br />Field Copy (3 of 3) <br />ii <br />I <br />1111111 oil 111111111111111111111111111111 <br />3;731:08102/2021IIIII <br />TEST DESCRIPTION - See Reverse side'for Container, Preservative and Sampling information <br />Client: San Joaquin County EHD <br />Address: San Joaquin Co. Environmental Health Dep <br />Water Quality Division <br />a <br />Attn: Michael Kith <br />a <br />1868 East Hazelton Ave. <br />b <br />Stockton, CA 95205 <br />3 <br />co0 <br />Phone: (209)468-3444 Fax: <br />w <br />a <br />_ <br />Contact Person: Michael Kith <br />� <br />A <br />Project Name: <br />Purchase Order Number: <br />g <br />a <br />w <br />3a <br />¢ <br />O <br />Quote Number: <br />y <br />U <br />a <br />rn <br />p <br />a' <br />U <br />G? <br />Samplers)- <br />2 <br />W <br />* <br />.2 <br />Sampling Fee: Pickup Fee: <br />E <br />t' <br />C <br />o <br />Q <br />Compositor Setup Date: / / Time: / <br />Q <br />8 <br />C <br />z <br />O <br />a a <br />P. <br />W <br />Lab Number: STK 3-17919 <br />0 <br />0 <br />0 <br />�% <br />o <br />�' <br />a? <br />o <br />o <br />T <br />F <br />R: <br />> <br />O <br />= o <br />Samp <br />Location Description <br />Date <br />Time <br />Num <br />Sampled <br />Sampled <br />>5 <br />F. <br />a <br />W O <br />'t <br />I <br />G <br />DW <br />Sub -3 <br />Remarks: <br />Relinquished Date: Time: <br />Relinquished Date: Time: <br />Relinquished Dais: Time: <br />Received By: Date: Time: <br />Received By: Dale: Time: <br />Received By: Date: I imc: <br />Corporate Offices & Laboratory Office & Laboratory <br />853 Corporation Street 2500 Stagecoach Road <br />Santa Paula, CA 93060 Stockton, CA 95215 <br />Phone: (805) 392-2000 Phone: (209) 942-0182 <br />Env Fax: (805) 525-4172 1 Ag Fax: (805) 392-2063 Fax: (209) 942-0423 <br />Office & Laboratory <br />563 E. Lindo <br />Chico, CA 95926 <br />Phone: (530) 343-5818 <br />Fax: (530) 343-3807 <br />Office & Laboratory <br />3442 Empresa Drive, Suite D <br />San Luis Obispo, CA 93401 <br />Phone: (805) 783-2940 <br />Fax: (805) 783-2912 <br />Office & Laboratory <br />9415 W. Goshen Avenue <br />Visalia, CA 93291 <br />Phone: (559) 734-9473 <br />Fax: (559) 734-8435 <br />
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