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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 KAFREALIAN ENGINEERING, INC. <br /> CHAIN OF CUSTODY <br /> f SAMPLER I SITE NA?+E L ADORESS I ANALYSES REOLIESTED I TURN ARQJIfD TIME: f <br /> oer� 1 1 1 1 f I 1 I R Q 9 tela y <br /> IWITNESSING AGENCYI 60 {�e �/Q m .4p <br /> I I <br /> ;�.� - .�- • •—� � I I 1 I I I I <br /> 1 sAIoLE I i 1 I I I I OF ' I SAMPLING f I I 1 ! ! I I [ E IN A Is c S I <br /> I ID NO. f DATE f TIME SO(L fWATERIGRAN CCHPlcONt.; LOCATION I I <br /> I <br /> 1 - s ,, I Ill I 1 I lY Ivl I I 1 I I 1 162— <br /> all <br /> 6Z 1 <br /> 1 ( <br /> �17w�t' jY.� �r � I ✓ I I I/I I S I ( � I f I I 1 1 f / -� 1 <br /> I Pf� <br /> I /, I I l/I I✓f f l ! 1 � 1 I 1 I I I I �� I <br /> L/I <br /> bell ishedby. (Sign lure) 1 Date/ Ime I Recei ..J by: i e) I The following MUST BE Completed by the laboratory accepting samples I <br /> I / I for anelysis: f <br /> 1. Nave all smptes rete+v for analysis been stored in Ice? f <br /> IRelinquished by: (Signature) I Date/Time I Rece: .' by: (Signature) 1 <br /> I 1 I I. Will soples remain r gereted until ar►elrted? f <br /> IRelinquished by: (Signature) I Date/time ! Recel-eiJ by: (Signature) 13." Did arty samples received for analysis have head space? 1 <br /> I R I I ld 1 <br /> w i. Were samples in app iate containers and property packaged? I <br /> (Relinquished by: (Signature) I Date/Time I Rete: ,4 by: (Signature) I I <br /> I I I I gnaturr Title Dat I <br />
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