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COMPLIANCE INFO_2024
Environmental Health - Public
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0548956
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COMPLIANCE INFO_2024
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Last modified
3/27/2024 9:57:44 AM
Creation date
3/8/2024 2:22:13 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2024
RECORD_ID
PR0548956
PE
1609
FACILITY_ID
FA0028074
FACILITY_NAME
DOGTOWN COTTAGE KITCHEN
STREET_NUMBER
24400
Direction
N
STREET_NAME
JACKTONE
STREET_TYPE
RD
City
ACAMPO
Zip
95220
CURRENT_STATUS
01
SITE_LOCATION
24400 N JACKTONE RD
P_LOCATION
99
QC Status
Approved
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EHD - Public
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Laboratory Report <br />Introduction: This report package contains a total of 3 pages divided into 3 sections: <br />Case Narrative (1 page) : An overview of the work performed at FGL. <br />Sample Results (1 page) : Results for each sample submitted. <br />Quality Control (1 page) : Supporting Quality Control (QC) results. <br />February 5, 2024 <br />Lab No. : STK2431067 <br />Pamela George <br /> Customer No. : 3019438 <br />24400 N. Jack Tone Road <br />Acampo, CA 95220 <br />Case Narrative <br />This Case Narrative pertains to the following samples: <br />Sample Description <br /> <br />Date Sampled <br /> <br />Date Received FGI, Lab No. Matrix <br /> <br />Pressure Tank <br /> <br />01/23/2024 <br /> <br />01/23/2024 <br /> <br />STK2431067-001 <br /> <br />DW <br /> <br />Sampling and Receipt Information: The Sample was performed by FGL. <br />The Sample was received, prepared and analyzed within the method specified holding times. All samples arrived at 8.3 ° <br />C. All samples were checked for pH if acid or base preservation is required (except for VOAs). For details of sample <br />receipt information, please see the associated Chain of Custody and Condition Upon Receipt Form. <br />Quality Control: All samples were prepared and analyzed according to established quality control criteria. Any exceptions are noted <br />in the Quality Control Section of this report. <br />Test Summary <br />SM 4500-NO3 F Preparation and analysis performed by FGL-Santa Paula (FGL-SP ELAP# 1573) <br />Certification: I certify that this data package is in compliance with ELAP standards, both technically and for <br />completeness, except for any conditions listed above and in the QC Section. Release of the data contained in this data <br />package is authorized by the Laboratory Director or his designee, as verified by the following electronic signature. This <br />report shall not be reproduced except in full, without the written approval of the laboratory. <br />ICD: JJL <br />Digitally signed by Kelly A. Dwulahoo, B.S. <br />Approved By Kelly A. Dunnahoo, B. S. Title: Laboratory Director <br />Date: 2024-02-05 <br />Section: Case Narrative Page 1 of 3 Page 1 of 3 <br />Corporate Offices & Laboratory <br />853 Corporation Street <br />Santa Paula, CA 93060 <br />TEL: (805)392-2000 <br />Env FAX: (805)525-4172 / Ag FAX: <br />CA ELAP Certification No. 1573 <br />Office & Laboratory <br />2500 Stagecoach Road <br />Stockton, CA 95215 <br />TEL: (209)942-0182 <br />(805)392-2063 FAX: (209)942-0423 <br />CA ELAP Certification No. 1563 <br />Office & Laboratory <br />563 E. Lindo Avenue <br />Chico, CA 95926 <br />TEL: (530)343-5818 <br />FAX: (530)343-3807 <br />CA ELAP Certification No. 2670 <br />Office & Laboratory <br />3442 Empresa Drive, Suite D <br />San Luis Obispo, CA 93401 <br />TEL: (805)783-2940 <br />FAX: (805)783-2912 <br />CA ELAP Certification No. 2775 <br />Office & Laboratory <br />9415W. Goshen Avenue <br />Visalia, CA 93291 <br />TEL: (559)734-9473 <br />FAX: (559)734-8435 <br />CA ELAP Certification No. 2810
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