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ARCHIVED REPORTS_XR0004207
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_XR0004207
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Entry Properties
Last modified
2/12/2020 10:35:42 AM
Creation date
2/12/2020 8:44:11 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004207
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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M P D 0 Services, Inc. <br /> 2401 Stanwell Drlva, Sulto 400, Concord, CA 94620 <br /> Tel (510) 602 5120 Fax 15101 689 1918 <br /> CHAIN OF CUSTODY <br /> SAMPLER UNOCAL rog M,-)L� ANALYSES REQUESTED <br /> VARTKES TASHDJIAN SIS # 6e—15-- CITY L csC.z t TURN AROUND TIME <br /> 1� ? to N <br /> WITNESSING AGENCY ADDRESS tr �.t !L �E 0'7C� a ! Q LLJ <br /> c? x o oUJI 4 <br /> 0 r <br /> _ SAMPLING i O ly J <br /> WAREMARKS <br /> SAMPLE ID NO DATE TIME TER EAB COMP NO OF CONT LOCATION <br /> 7 <br /> y � 7 vc_, 401919.%7,A0- <br /> �7IU� tr � <br /> t/-&14 40919.t:i 8 <br /> M W > <br /> 39 <br /> -` Nu0 <br /> 409-11960 <br /> 409"991 <br /> M('4_1 4 Z -E 40g19f;2 <br /> M ! ' <br /> 77-77y icy �i z L, a, <br /> ,� ��,. ��� s t x 40919Q <br /> -t X 4091964 <br /> x 40q'965 <br /> r=�EGA �d I vc) 1 a, 40919196 Af <br /> i R i p IT a tiL x X <br /> rls4'Te r I nl/� � r�ea ,t�rf� 4[191q�'y <br /> r` THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> RELINP SHED BY DATEJTIME RECEIVEDY rh 1 HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> 1, "' 1�, <br /> 1112�. J <br /> IS TU 1 ISIGNATUREI / / 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> L"a", <br /> ISIG IGNATUR 1 3 010 ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> �� cryL �1z e z, cry ? 7 <br /> ISIGNATUREI ISIGNATUREI 4 WERE SAMPLES IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? <br /> ISIGNATUREI ISIGNATUREI SIGNATURE TITLE DATE <br />
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