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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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• i 0 <br /> r, <br /> K E KAPREALIAN ENGINEERING, INC. <br /> CHAIN OF CUSTODY <br /> {SAMPLERI SITE NAME t ADDRESS ANALYSES REQUESTED TURN eAR�OUND TIME: <br /> � r1 / Vnac.a/� �p�• II <br /> 1 <br /> ,'WITNESSING AGENCY <br /> I <br /> I f ! I 1 I I I Ne• I I �i I I I I 1 I I <br /> SAMPLE f I I I I I I OF I SAMPLING J �l I I I I I I It E to A R K 5 <br /> I ID NO. ! DATE I TIME I SOIL I WTERIGAABICaIPJCDNT,; LOCATION <br /> see <br /> f l� <br /> I w _ o01 <br /> ! w IW <br /> I w ` <br /> I (,1 -V <br /> (self fished by: Signa ure) I D te/ Ime I Regie r-.4 d.by. Is7ie) I The following MUST BE completed by the laboratory accepting samples <br /> for analysis: I <br /> 1. Neve all samples r ived for anstysis been stored in ice? I <br /> IRelinqulshed by: (Signature) I Date/Time ! Receirri by: (Signature) I <br /> I { 2. will samptes remain frigerated until analyzed? } <br /> I nqu' by: (Signature) I Date/Time I Recti-wi by: (Signature) 3. Did any samples recei for analysis have head spate? ! <br /> self fished I <br /> i. were samples in ropriate containers and property packaged? <br /> (Relinquished by: (Signature) I Date/Time I Rece;..d by: (Signature) I I <br /> I I I I ignsture Title 0ate 1 <br />
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