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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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a <br /> r `t� <br /> ;x3 16 <br /> Y - <br /> KAPRIEALIAN ENGINEERINGo INC. <br /> C)IAXN OF CUSTODY ------------ <br /> ANALYSES ACOLIES1E0 I TURN AROLa10 TIME: 1 <br /> SITE NAME L ADDRESSi I <br /> ISAHPLER / Of� <br /> oc�, (y cli{f <br /> i �.on s I G/,t'/d�sf•�� - G <br /> 1yITNESSING AGENCY <br /> I l i <br /> I 11 1 <br /> OE14ARI(s I <br /> I I ! I I <br /> OF I SAAPLING <br /> i ISMO. I DATE I TIME I soli IWTERIfJ1ABICMP WNT.I LOCATION <br /> I IFue� . 'e"i <br /> I I Vi l 1 11/I eX I <br /> 1 1 1 1 1 1 I <br /> ij _ f l ! I �/ i I ! I 1 ► 1 <br /> I �( I l � l 1 l�l I ►c 1 <br /> IS <br /> I <br /> I I �1 { I l l 1! I ✓ I E I l 1 <br /> !1 <br /> I I ✓ I I 1 I I I i �� I <br /> I I t/ I I ! I I i f ✓ I <br /> V I V/ <br /> if I <br /> I I The fallowing MUST RE e,Vleted by the laboratOrY accepting samples <br /> Illelinquished try: (SipM1atwe) I Dote/Time I Ree }veil hyi (Si4ruture) I <br /> for wQlI Have Ott I � ` I+1 •� , I '�l. � �.,\, 1. <br /> Have (l samples received for analysis been stored in ice? j <br /> r {t 1 <br /> IRetinquished by: (Sig-turf) I Date/tier I Received by: (Signature) 12, will samples remain refrigerated Until enalyted) I <br /> Date/Timr I Received by: (Signatwe) 3. Did any sample$ received for analysis have hood spacer <br /> IRelinquished by: (Signetwc) I I I L./ <br /> were samples in appropriate conteixrs and properly pii <br /> _ I <br /> tinquished by: (Signature) I Oate/Time I Received by: (SignatwaJ I I( i 1 r S <br /> I Datc I <br /> i ! ' Signature Title <br /> I i <br />
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