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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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KKAPREALIAN ENGINEERING, INC. ' <br /> CHAIN OF CUSTODY <br /> ISAMPLER I SITE NAME Z ADDRESS I AMALY`t$ REQUESTED I TURN AROUND TIME: I <br /> On d 04! 1 , Oa I <br /> IWITNESSING AGENCY I 6Q/ f(e,flerNan All. <br /> I I <br /> I I I I i I I I N�• I I + I f f I I I f I <br /> SAMPLE I I I I I I I OF I sAMPLnic II I I I I I I R E p R R c S I <br /> 10 N0. I DATE I TIME I SOIL IWATERIGRANICOMPICONT.1 LOCATION <br /> I I I I I I I �I <br /> WS Sa e Sa I <br /> y <br /> I <br /> 1 I L I 1 I I I I I I I I I l <br /> I I I 1 1 I I I i I f I f I I I I I <br /> I I 1 I i I I I I I I I I I I I I I <br /> 1 <br /> I <br /> IReti ished by: (S gnatur ) I De e/tl /� 1 ;"Ct <br /> i the fottowtUS <br /> nq MT BE C*Vt eted by the laboratory accepting sarles I <br /> I I ( for analysis: I <br /> {N 1. Have all samples r Se€ved for analysis been stored in Ice! I <br /> (Relinquished (br: (signature) i Date/Time I Recei br: ignature) I '� I <br /> I I I 12. Witt aaMtes r7!jnjefrigerated until analyzed? I <br /> ✓ I <br /> IRelinquished by: (Signature) Date/time Received : (Signature)I I by 3. Did any samples received for analysis have head space! � I <br /> I I I I Z40 I <br /> i -• _ ' •••-•--- i. Were sn+ptes i ropriote containers and properly packaged? 1 <br /> Isetinquished by: (Signature) I Date/Time I Received by: (Signature) <br /> I I I I 5ignn!Ure litte Date I <br />
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