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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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K KAPREALIAN ENGINEERING, INC. - <br /> CRAIK OF CUSTODY <br /> (SAMPLE I SITE RARE L ADDRESS I ANAWT 5 REoUESTED I TURN ARpJND TIME: i <br /> I u1 I I I I I I I <br /> IYITNESSING AGENCY I gyp/ K�rflPmdn �r7. I �I I I I I I I I <br /> I I I 1 1 1 1 1 1 I <br /> 1 1 1 1 1 1 I <br /> I I I I I I I I No• I I `ih'E I I I 1 I I I <br /> I <br /> SAMPLE ( I I I I I I OF I SAMPLING I �I I I I I I I E It A R >K i I <br /> I 14 NO. I DATE I TIME I SOIL IYATEt1IGRAGICOMPICONT-1 LOCATION <br /> �� S '� I ! ✓1 1 �I I j I I ✓i I I 1 I I (p6 <br /> l S I <br /> I <br /> -1 �S I r/ I I <br /> I <br /> f <br /> I �_ �,� r• I I �! I �/I I I ! f/ I I I ! I I I ��� 1 <br /> I <br /> IW irquish by: Signa ) 1 Da a/Time I Received by: gnat ) I the fol,lowltq MUST BE completed by the laboratory accepting saMles I <br /> I / l for analysis: I <br /> W 1. (leve all samples received analysis been stored in ice? I <br /> Iaetinwished by: (Signature) I Date/time I Zt; IY: (Signature) I I <br /> I I I 12. Yiil sovi es remain rSisiQerated %ntit ansly:edf I <br /> iRelinwished by: (Signature) I Date/Time 1 Received by: (Signature) ]. Did any samples received for analysis hive head space? I <br /> I I I I <br /> 41,9 <br /> i. were sovies in aff►�ate containers and property packaged? } <br /> IRelinquished by: (Signature) I Date/Time ! Received by: (signature) I I <br /> 1 I I II <br /> I I St4r+a'ure title Dat I <br /> i <br />
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