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ARCHIVED REPORTS_XR0012738
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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K
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KETTLEMAN
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420
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3500 - Local Oversight Program
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PR0545336
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ARCHIVED REPORTS_XR0012738
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Entry Properties
Last modified
2/10/2020 10:42:18 PM
Creation date
2/10/2020 4:08:28 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012738
RECORD_ID
PR0545336
PE
3528
FACILITY_ID
FA0003776
FACILITY_NAME
KWIK SERV LODI BW 113*
STREET_NUMBER
420
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06202042
CURRENT_STATUS
02
SITE_LOCATION
420 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\sballwahn
Tags
EHD - Public
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r !- ')3-1 Send results tu: <br /> Phone(JIG, ..s�t ttl AEGIS Environmental Consultants, Inc. Aegis F'sl,vironmenlal <br /> I,'AX (910)786-7830 8til Riverside,Suite C <br /> SIllll�)�(' [(]{!1111�tC.11ltlll/l''ie�(� L1litiil (1r�;L1St[1(�y 1lL'C[lC(I l oseville,CA 95678 <br /> For Shell Projects Only <br /> 244 -441L - 6120'2' <br /> Site Address: WIC: <br /> All Proje2�ia <br /> AFE: <br /> - CT/DL: <br /> Shipped Fay: yll�f ' 2Shipped To: Shell Engineer. <br /> Project <br /> '� - Hazardous Materials Suspected?{yc o).) <br /> J 6 <br /> 5any!!iug Sample No.or Analysis <br /> Point Lrs red <br /> ocalion Field ID# Date 1' a Containers Re ai <br /> `ALT ]t' (�U .� c :Hl �L E !b i <br /> '�yL�I�� <br /> i <br /> Sample4s)(signature); C <br /> Field ID Relinquish IS (sin ore) Received Fl (si attire) Fl:ttelTime Comments <br /> Scaled for shipment by:{signature)' Date(1'ime:��t' % I/ ! Shipment Method: ! �J <br /> Received for Lab b (signature) <br /> t _ Date rime: ' `�� '7X0, CQnimcatS: <br /> EE 's <br /> teceiving Laboratory: Please return original form after signing;for receipt of ampler. <br /> \Vliitrlrh igir d 1'cll null:h C'J'Y t'A/1 ilc C"pv _ __ <br />
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