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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 <br /> KAPREALIAN ENGINEERING, INC. <br /> CHAIN OF CUSTODY <br /> IsAMpLiR I SITE NAME t/ADDRESS I ANALT;rS REOUESIED I TURN AROUND TIME: <br /> on 01�e? o / I I I i I I I <br /> iWITNESSING AGENCY I i�Q� i� • Kpl�IPrxan �►/1. I ( I I I I I I <br /> i I I I I I I I NO. 1 I l l I I I I 1 I I <br /> I WLE I I I I I I I OF I SAM►LING I I I f I I I tt E N A " x ; i <br /> IO M0. I DATE I TIME I SOIL 16ATEO I GRAS IC(POICONT-I LOCATION <br /> I <br /> Co roI <br /> I I I I I I I l I I ! I I I I I I I <br /> itell fished by• (S gnatur ) ( Da a/Ti I Recel i The following MUST BE completed by the laboratory attepting samples I <br /> for analysis: I <br /> 1. Move all seniles rseived for analysis been stored in Ice! I <br /> (Relinquished by: (Slgruture) I Date/Time ! Recel by: ( Ipnature) I I <br /> I I 12. Will samples remain efrigersted until analyzed? I <br /> IRelinquished by: (Signature) I Date/Time I Received by: (Signature) ( 3. Did any samples received for analysis have head space? I <br /> i. were samples i ropriste containers and properly packaged? i <br /> (Relinquished by: (Signature) I Date/Time I Received by: (Signature) 1 <br /> I I I 1 r <br /> I + I Sigr+,ture Title Date I <br />
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