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ARCHIVED REPORTS_XR0004164
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_XR0004164
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Entry Properties
Last modified
2/12/2020 9:58:48 AM
Creation date
2/12/2020 8:41:12 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004164
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
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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to <br /> KAPREALIAN E3,%( RING i <br /> I N C 0 R f �Cjj''''HH`i�`T E D / <br /> i <br /> CKAIN OF CUSTODY <br /> SAMPLER / SITE NAME & ADDRESS ANALYSES REQUESTED TURN AROUND TIME: <br /> WITNESSING AGENCY U/vdc bJ <br /> No. <br /> SAMPLE OF SAMPLING R E M A R K S <br /> 10 NO. DATE TINE SOIL WATER GRAB COMP CONT. LOCATION <br /> 1 7-13 7t )< 1 2-1 v16 A <br /> ;A4 <br /> x <br /> u >1 <br /> Inad <br /> Ina <br /> Relinquished by: (Signature) D to/Time Received by-. (Signature)_ The following MUST BE completed by the laboratory accepting samples <br /> for analysis: <br /> I Have all samples received foyanalysis been stored in icer <br /> Rel ryquishe b (Signature) Date/Time Re eived b : (St ature) <br /> �rIN 7•/�J .r�2/�7j �� _ 2. Will samples remain refrigerated until analyzed? <br /> Relinquished by: (Signature) Date/Time Receied by: (Signature) 3. Did any samples received If gr1grlalysis have head space? _- <br /> 4. Were samples in appropriate containers and properly packaged? <br /> Relinquisd by: (Signature) Date/Time Re ived b (Signat pe) <br /> Signa ure Title Date <br /> 2401 Stanwell Drive,Suite 400 <br /> Gwtcurd,Q1llarnia 94520 <br /> Tel:510.602.5100 Fax:510687MO2 <br />
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