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ARCHIVED REPORTS_XR0004212
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_XR0004212
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Entry Properties
Last modified
2/12/2020 10:06:28 AM
Creation date
2/12/2020 8:47:22 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004212
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
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SJGOV\sballwahn
Tags
EHD - Public
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M P D S Services, Inc. <br /> 2401 Stanwell OfIve. Sults 400,Concord, CA 94620 _ <br /> Tal. (610) 602-6120 Fax. 1610) 689-1918 <br /> CHAIN OF CUSTODY r <br /> SAMPLER UNOCAL ANALYSES REQUESTED <br /> SIS # bC 1 S� CITY C c .sem TURN AROUND TIME <br /> VARTKES TASHDJ)AN _ <br /> 1a f N N 'J 'i_' <br /> WITNESSING AGENCY ADDRESS 601 L f l� LC �ar7,a�r fns, q w T <br /> C7 <br /> SAMPLING 9L M � D I j REMARKS <br /> SAMPLE ID NO DATE TIME RTER ,!A COMP NO OF CONT LOCATION H on A. <br /> Nr �I;cls <br /> 6 3I3 I9 }( 7 U d �, t. X G l <br /> NV <br /> 7 vu4, <br /> MG,Q �/3114q X f C/&Al V <br /> THE FOLLOWING MUST BE COMPLETED BY THE LABORATORY ACCEPTING SAMPLES FOR ANALYSES <br /> RELINQUISHED BY. DATE/TIME / RECEIVED BY I HAVE ALL SAMPLES RECEIVED FOR ANALYSIS BEEN STORED ON ICE? <br /> ISIGNATUREI �vL(( IS GNAFUREI 2 WILL SAMPLES REMAIN REFRIGERATED UNTIL ANALYZED? <br /> ISIG TU y ISIGNXTUREJ t13 DID ANY SAMPLES RECEIVED FOR ANALYSIS HAVE HEAD SPACE? <br /> ISL4HATURE! ISIGNA REI 4 WERE SAMPLES IN APPROPRIATE CONTAINERS AND PROPERLY PACKAGED? <br /> (SIGNATURE) ISIGNATuR0 SIGNA�T RE TITLE DATE <br /> (I SI <br /> I171� <br />
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