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ARCHIVED REPORTS_XR0004166
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_XR0004166
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Entry Properties
Last modified
2/12/2020 10:13:58 AM
Creation date
2/12/2020 8:42:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004166
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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• <br /> K KAPREALIAN ENGINEERING, INC. <br /> CHAIN OF CUSTODY <br /> ISAMPLER I SITE NAME L ADDRESS ANALYSES RCOMSTED I TURN AROl1HD TIME: I <br /> 1 r� --- <br /> _c� _ <br /> IWITHESSING AGENCY I 60 I <br /> I I �r I I I f I I I i GG <br /> I 1 I f I I f I �• 1 . ISI I i I I , i I <br /> I SAMPLE I I I I I , f OF I SAMPLING <br /> I ID NO. I DATE I TIME I SOIL IWATERIGRA11COMPICONT.I LOCATION I I I f I I I I <br /> Nwl-11 -3 I <br /> 1 <br /> 1towZ1 <br /> -T'TT-1 <br /> 1)4 ! I I I I I I <br /> M <br /> I <br /> yC I Y, I I y I f l •-I I I I I I f <br /> 1 -41 4-1 1 1 1 - -1----1 <br /> Joel irrquish by: (Signature) I bete/Time I Recelby: (Signature) I The following MUST BE cem(eted by the laboratory accepting samples I <br /> I i f— 3- SZ 1 j.zb /l for analysis:!w ( f I <br /> 1. Have all swrles received for analysis been stored in ice? I <br /> (Relinquished by: (Signature) I Date/Time I Received by: (Signature) I 1 <br /> 1 f i 2. Will aaeples Vemaim refrigerated until analysed? I <br /> 1Rel inquished by: (Signature) { Date/Time I Received by: (Signature) 13. Did any swm[4 received for analysis have head space? I <br /> �— 4. Were samples in appropriate containers and properly packaged? I <br /> 1Ret1r%Wished by: (Signature) I Date/Time I Recel.L,,: by: (Signature) I I <br /> I 1 I � f <br /> I I 5lgnat� a Title Date I <br />
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