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ARCHIVED REPORTS_XR0003633
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_XR0003633
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Entry Properties
Last modified
2/10/2020 5:22:47 PM
Creation date
2/10/2020 4:17:26 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003633
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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• � J1 <br /> /e_ <br /> SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dale -f /1z <br /> _ RETAIL ENVIRONMENTAL ENGINEERING . WEST Sengl No — Page of Site Address Analysis Required LABS: `JC:n 1 h la—, <br /> LA-) <br /> W��•�� 2(f,4— 4CHECK ONE(1)BOX ONLY CF/DT TURN AROUND TIMI• <br /> _ 1 11P— <br /> (�z�Z <br /> Shc11 Engineer lion No ICJ Quarterly Monitoring ing A 5461 24 ho <br /> l X E 1"l _i f-. Fan 0 S- IV <br /> I1"g Site Invesugsteon 4 ] SM 1 ,S hours ] ] <br /> Consultant Name& Address. - -- — ---— — — Sal for disposal ( ] 5442 15 days xNo mal) <br /> E IIICON Water tug disimal 5413 <br /> � �113,3 IV, ,., ,�• Oilier <br /> Consullant Contact. phone No i(o Au Sample-Syr O&M ]� 5452 I I <br /> f � 3300 W.K MFc ys [ NOTE Notiry Loh w <br /> I� tS4SO&M 5453 N � soon a pwsihk�>< <br /> Cammenis G �� _Q C-7 Ci j Other `� 24Hahrs TAT - <br /> MATERIAL SAMPLE <br /> Sampled By p�, ��, sI` CONDITION/ <br /> Printed Nunc T �/'7T1 DESCRIPTION COMMENTS <br /> SampIc ID — Date Sots Water Air NO or pq > <br /> 11h LU Ix <br /> Fig-1.4 Egaak_ <br /> xIt 5x <br /> el uis - s nrc} -- ----- Prim name Dae /+� R v. ( ign 1 Printed e <br /> Ix, L�rO Trate Sal: + Irl"Ic�: <br /> iris-abed By (signature) primed name Dale Rauval(signatute) printed name <br /> These Time-- <br /> Relinquished By (signature) Printed name Received(signature) Pointed name Date <br /> Tone cmc <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN OF-CUSTODY WITH INVOICE AND RESULTS <br /> rtil 1(tvuKro I)atc I0/0/91 <br />
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