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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 KA.' AEALIAN ENGtiINEERING, INC. <br /> C1E[AIN OF CUSTODY <br /> ISAMFLER I SITE NAME R ADDRESS I ANALYSES REi)IIESTED ! TURN AROUND TIME: I <br /> I .�,� I V11ac.a�- l.aa'r• I 1 I 1 I I I 1 1 <br /> IwITNESSING AGENCY <br /> A- <br /> T- <br /> OF ! SAMPLINGI I i ! i I I I r r W r r [s I <br /> I ID NO. I DATE I T 104 I SOIL IwATERIGRAGICOMPICONT-1 LOCATION <br /> 112,0 j 0 (5 <br /> 6-1 <br /> 1 <br /> � d � �--- <br /> 1 <br /> I <br /> I vl <br /> 1 _ I r� I I of I ✓I I I I ISI I I 1 1 I I 0Zj <br /> In <br /> ✓i I f I I (/I I I I I I I dZ3 I <br /> JRell fished by: (Signature I D7tetime I Rece:..d by: (Signa we The following MUST 9E completed by the laboratory accepting sanptes J <br /> 1 I ` I --�� for analysis: I <br /> �.� 1. Neve all samples recei for analysis been stored in ice? <br /> naI <br /> (Relinquished by: (Signature) Date/Time 1 Date/Time I Rct: : gna <br /> .d by: CSI J <br /> 12. will samples remain rigerated until snalyzed7 I <br /> I <br /> (Relinquished by: (Signature) I Date/Time 1 ReW ._ by: (Sigrtsture) 3. Did any samples re��rlved for analysis have head spacer I <br /> /�U I <br /> i. were samples in aper a containers and property pockageM 1 <br /> (Relinquished by: (Signature) I Date/Time I Recei.,.%d by: (Signature) l <br /> I 1 I l Z I <br /> 1 I I ( ynature Title Date J <br /> i <br />
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