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ARCHIVED REPORTS_XR0012743
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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601
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3500 - Local Oversight Program
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PR0545338
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ARCHIVED REPORTS_XR0012743
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Entry Properties
Last modified
4/9/2020 9:06:40 AM
Creation date
2/12/2020 8:31:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012743
RECORD_ID
PR0545338
PE
3528
FACILITY_ID
FA0003803
FACILITY_NAME
KETTLEMAN CHEVRON
STREET_NUMBER
601
Direction
E
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04728006
CURRENT_STATUS
02
SITE_LOCATION
601 E KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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e <br /> KAPREALIAN ENGINEERING, INC. <br /> CttAIW OF CUSTODY <br /> ANALYSES RCDULSTED I TURN AROUND TINE: ` <br /> i SITE NAME t ADDRESS 1 �`� Z �f• I <br /> SAMPLER Ta 17 ,y <br /> �.� 7 r <br /> WITNESSING AGENCY <br /> V}+ I I I I 1 + <br /> i I I I <br /> 1 <br /> . I I <br /> Nv. I 1 Ei11 , I I I I it I <br /> I I + I 1 I I <br /> OF I SAMPLING <br /> I <br /> SAMPL <br /> I !ol AT tDN I <br /> D NDE I DAT£ I TIME I SOIL INATERIGRABICDMPIC61+T.1 ax, <br /> 1 , + ✓ , I I ✓I I `�k ll •Br I r/I r/ I L oiZ- t` I y�5�/mss 7 <br /> I z r f I I 1 I I i/l l rd'Fe ria G 4' I (/I /1 1 1 I <br /> I <br /> V , <br /> k + I I I I I + <br /> I I I I I I i I I 4 I 1 <br /> I I I I 1 I <br /> + I I I + I <br /> I k 1 I ! 1 I I I I <br /> 1 ! 1 1 1 1 1 1 <br /> The following MUST BE canpieted by the laboratory acceptingstnplcs <br /> Dete/Time <br /> ��— I eceived br: (signature) I <br /> IRellnWished by: (Signature) I .,. I {ar analysts: ! <br /> 1. Have all. sm,Qtes rec`ired for analysis been stared in ice? <br /> Relinquished by: (Signature) I` Date/Time I 0.\eived by. (signature) 12. Uill omples remin refrigerated until anatyxedT <br /> 1 I 6 1, <br /> I <br /> 1 <br /> Lysis have heed spaces <br /> pate/Time Received kA: (Siuturc) 3. Did sny swples received for ana <br /> IRetinquished by: (Signature) kI <br /> / <br /> I , L. Were\wTles in appropriate containers and property Packaged'' <br /> y c I <br /> IReligiished by: (signature) Date/Time I Received by: (Signature) <br /> n ��_ Title <br /> I <br /> liic Date <br />
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