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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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o n. <br /> falx , <br /> - 3 <br /> IK ItAPREALIAN ENGINEERING, INC. <br /> fCHAIN OF CUSTODY <br /> ISAHPLER I E SITE NAME t ADDRESS I AUALYSES REDUESTE0 I TURN AR"O Tlht: <br /> 1 <br /> I I t�ua C' # 1 5 — L C) 4 5 [ <br /> IVITNESSING AGENCY ! ��� �v`� <br /> I IG 01 I�. ���-�� I� <br /> I--�,— I I 1 ! I No• I <br /> I sAHals I I i I I i I OF I SAMPLING <br /> ! ID NO. I DATE I TINE I SOIL IYATERIGRAHICDRAICONT.I LOCATl�t <br /> I <br /> ���wy f991i I I I It/!� 1�Toc>l�lLl� I✓I ✓1 1 I I I -'s C.) z� I <br /> I ICOwy X I x/19 a i I t/1 E, r"7 i <br /> Fr-�--- I I ! I 1/ <br /> I ' /I�I <br /> : "� � Y13/19911 I czI v <br /> � �i f1� 411 1 ✓ I I It/I �r 1 l✓I�i I 1 l I 1 �'� 1 <br /> I <br /> �} I3119�1! <br /> l <br /> QB <br /> fJ 1319 <br /> ! <br /> ! I I I f I I 1 I I I I 1 1 1 1 1 1 <br /> I I ! I f I I I I I 1 I ! 1 I ! I 1 <br /> 1 el squished Ignature I Date/Time Deceived by: (SI tune) � The following HOST BE compteted.by the laboratory accepting aaVtes I <br /> I I 3�2L�41 I� I r ' I for analysis: <br /> 1. Have all samples received for analysis been stored in Ice? I <br /> Itellrr.iished by: (Signature) I Dale/Time I Received by: (Signature) I 1 <br /> 12. Wilt samples remain refrigerated until analyzed? 1 <br /> � <br /> I � I <br /> Relinquiahed by: (Signature) iv <br /> I Date/Time I Receed W.. (Signature) S. Did arty sarples received for analysis have head space? <br /> ! 1 I I JQ0 I <br /> r., ver samptes in epprapriate containers and property packaged) 1 <br /> •tirquished by: (Signature) 1 Dete/Time I R by: [signet 1 I `/ ! <br /> +n , I 2.b <br /> I.3I�Iy>i{ � � ( azure Tit{e Date 1 <br /> 4 11 � <br />
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