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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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• <br /> K KAPAEALIAN ENGINEERING, INC. <br /> CRAIN OF CUSTODY <br /> (SAMPLER I SITE KAM' L ADDRESS I ANALYSES REOUESTED I TURN AROUND TIME: I <br /> Look <br /> 6' <br /> I wl I I k I 1 I f <br /> IwiTNESSING AGENCY I 601 K4-1114M4-14n, I I I I I I I I <br /> •--; � f I I I I I I <br /> f SAivLE I I f I I I I OF I SAMPLING 10.I I I I I I I R E 11 A R C S I <br /> I ID NO. I DATE I TIME I SOIL IYATERIGRABICOIPICONT. I' LOCATION <br /> I _ I , , ✓ I 1�1 I R Q a � I v l I I I I I I �l C� j ��-y 1 <br /> DZj I <br /> I <br /> T <br /> I <br /> I I I f I f l l I I I ! I I I I I I <br /> IRelinquished bv* (Sign ture) I Date/ ime I Rece. '.d • i(Si ur The following MUST BE completed by the laboratory accepting Sanales I <br /> I � I l � I for analysts: <br /> pe� 4" dI <br /> 1. Nave all ssmplrs r ived for analysis been stored in ice? I <br /> IRelinWished by: (Signature) I ate/Time I ecet:d by: (Signature) I <br /> I I 12. will samples rens efrigerated until analyzed? I <br /> (Relinquished by: (Signature) I Date/Time I Reeei.•.J by: (Signature) 3. Did any samles received for analysis have head space? I <br /> 4. were samples in opriate containers and properly packaged? I <br /> Irtelinquished by: (Signature) I Date/lime I Recei%..j by: (Signature) I <br /> Signature Title D c <br />
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