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ARCHIVED REPORTS_XR0003569
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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401
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3500 - Local Oversight Program
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PR0545335
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ARCHIVED REPORTS_XR0003569
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Entry Properties
Last modified
2/11/2020 7:30:20 PM
Creation date
2/11/2020 11:20:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003569
RECORD_ID
PR0545335
PE
3528
FACILITY_ID
FA0003603
FACILITY_NAME
TESORO (SPEEDWAY XP) 68152
STREET_NUMBER
401
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04513019
CURRENT_STATUS
02
SITE_LOCATION
401 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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mar Inc. r`AC®N <br /> CHAIN OF CUSTODY REPORT <br /> unran w , <br /> Beacon Station No. Sampler(Print Name) D to n F rm No., <br /> --- ANALYSES 3 of s <br /> Project No. i3ampler (Signature) '� f '06 <br /> d � �d►��nkl 7t+ * <br /> co <br /> Project Location Affiliation 0 m <br /> U, c <br /> m 0 <br /> L1 C G{, e a v/ n0h'2el W <br /> Sample No./Identification Date Time Lab No. m � � z REMARKS <br /> L6)5'—� - 6 1 .3 �C 1 Soi` r <br /> �v / 7 ` '1 Sar <br /> I 7t3 8 r o � <br /> B- 2 -16 c5-/ .S 6 a:l <br /> t i ( r'J <br /> 3 31 <br /> Relinquished by: (Signature/Affiliation) Date Time Received by:(SignaturelAf iliati n) Dae Time <br /> deli.quished by: (SignaturelAffi is ion) 7 to Time Received by: (Signa( rel ffiliation)` to Time <br /> Yom. i - //c� =0< t P [�� plx %a?_D2 <br /> Relinquis ed by: (SignaturelAffi iation) Date Time Receive : (Signature/Aflmation) Date Time <br /> Report & I Bill l : ULT AMAR INC. <br /> 525 West Third Street <br /> h �l Gi Hanford, C+ 93230 <br /> Attention: ! {N 1► GT f l -_ <br /> WHITE: Return to Client with Report YELLOW: Laboratory Copy PINK: Originator Copy 32 "f°° <br />
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