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ARCHIVED REPORTS_XR0004171
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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501
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3500 - Local Oversight Program
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PR0545337
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ARCHIVED REPORTS_XR0004171
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Entry Properties
Last modified
2/11/2020 3:37:04 PM
Creation date
2/11/2020 11:46:29 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004171
RECORD_ID
PR0545337
PE
3528
FACILITY_ID
FA0003629
FACILITY_NAME
ARCO STATION #434*
STREET_NUMBER
501
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
03119028
CURRENT_STATUS
02
SITE_LOCATION
501 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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0 <br /> SEQUOIA ANALYTICA&PLE RECEIPT LOG �• <br /> }NL}t+}ti +y p}}} b r} } Y } 4 Y b r)�A r4 +} J A J?. } V}KV r r)� rJ V J } } • } b MK r7 }r}n? r <br /> I } <br /> CLIENT NAME ��� WORKORDER' 0,58m <br /> REC BY (PRINT) DATE OF LOG-IN <br /> CIRCLE THE APPROPRIATE RESPONSE LAB SAMPLE DASH CLIENT CONTAINER SAMPLE DATE REMARKS <br /> 1 Custody Seal(s) Present/ bsent # # IDENTIFICATION DESCRIPTION MATRIX SAMP CONDITION ETC <br /> Intact/Broken` ; ol G "1,4 3 Zi r� <br /> 2 Custody Seal Nos Put In Remarks Section <br /> f 3 Chain-of-Custody 03 tt)' .3 <br /> Records Prese 1 Absent` 04 G{Jr <br /> i 4 Traffic Reports or Of (�(J– <br /> Packing List Present 0 X13 f Uplg- Z) <br /> 5 Alrbill Alrblll/Sticker <br /> #t Present l-pssi <br /> fi Airbill No <br /> x 7 Sample Tags Absent` <br /> } <br /> Sample Tag Nos /Not Listed <br /> € on Chain-of-Custody <br /> 8 Sample Condition Ina Broken*1 Leaking" <br /> 9 Does information on custody <br /> reports, traffic reports and <br /> sample tags agree? eE o• <br /> 10 Proper preservatives <br /> used Ce)s1 No" <br /> 11 Date Rec at Lab <br /> 12 Temp Rec at Lab ! dC <br /> > 13 Time Rec at Lab �. <br /> { 3•k"'W3{r •u ASN ♦ r Kr 7 ti ii i [[t r r { v k { r +v Ci A { it dF rM^C t v r •{ r <br /> ` if Circled, contact Project manager and attach record of resolution <br /> Revision 3121195 <br /> Page � of <br />
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