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ARCHIVED REPORTS_XR0004252
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KETTLEMAN
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3500 - Local Oversight Program
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PR0545338
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ARCHIVED REPORTS_XR0004252
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Entry Properties
Last modified
2/12/2020 10:04:25 AM
Creation date
2/12/2020 8:48:23 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004252
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 I --- I I ____ - _ .' '0 <br /> J �►�J <br /> KAPREALIAN ENGINEERING <br /> I li C 4 R P 0 R A T E D <br /> CHAIN OF CUSTODY <br /> SAM1sLEA SITE NAME t ADDRESS — ANALYSES REMESTED _ IURN AROUND Fmk <br /> WITNESSING AGENCY � r � M L <br /> NCI• {„ ItENA9KS <br /> SAMPLE OF SAMPLING — — <br /> ID NO, DALE TIME SOIL UATEA GAAB GOND CONT. LOCA rIOM-ALL le IqS72-- <br /> "'�•�� <br /> 2,9 <br /> 1 <br /> Rall hed by: (Si nature))/ Date/Time a ved by'. (Signature) G�r ,fig G} The following MUST BE comVteted L►y the laboratory accepting samples <br /> Y c�1 ' 1.�.. p --�! ti _ __ for anahave <br /> t Nave all sa+nplts received for analysis been stared In ices <br /> Ae shed (Signature) Da a/Time Aeceiv (5s a ure) -- <br /> �1 e97 <br /> y � 2 QM saeples r in iefrigerated until analyzed?Relinquished ipIe) Datt/Time ved by iSipnat ) i Did any saeples eiyed for analysis have Arad space? <br /> ( a1C1 4 Were samples in appropriate containers wW praperl/ packaged? <br /> Relinmauislfied tidy (Signature) Date/Time Received by, (Signature) <br /> It Date <br /> 24411%Mn�ft 11 I mw.,tiuur 40 <br /> 6Xll17rd (aide nir.9S4Id <br /> l'il 51Uf�(12`.If1U I mx 51+1(,NT+'1(all <br />
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