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ARCHIVED REPORTS_XR0004253
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_XR0004253
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Entry Properties
Last modified
2/12/2020 10:00:40 AM
Creation date
2/12/2020 8:48:38 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004253
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 KAPREALIAN Ei GINEERING, INC. <br /> CHAIN JOF CUSTODY <br /> !SAMPLER I SITE NAME 8 ADDRESS I ANALYSES REQUESTED I TURN AROUND TIME I <br /> IuITNESSING AGENCY I60 ! E. <br /> I 1 <br /> l --- t I <br /> I I ! I I I I IND <br /> SAMPLE I I I ! I I I Of I SAMPLING I 1Ll 4 1 1 1 I I 1 1 E It A R C S I <br /> I ID NO I DATE I TIME I SOIL I�(�!9ICOMPICONT I LOCATION <br /> IMw 13fi6�143I Q I I x 1 X l 1 3 1Mo� {�' CJS I y( f x l I ! I I 13L3 (a <br /> 1,qw 2 1 4 I P;r 1 I X 1 )( 1 1 2 1 4 4 I }( 1 1 I 1 1 1 1 1 <br /> I Mw3 ! 4 1443s 1 1 k' 1 )< 1 1 2 1 Y 1 x I I I I I I l <br /> ta—t <br />� I-- � - {— � t x t � - <br /> I MLJ I 1 P I I k f X 1 1 2 l y t I <br /> IMw6 1 -- ! P I I X Ik I 1 2 1 �7A I <br /> IMw ! 4 1 <br /> PAL, <br /> 1 3 1 Y y I x I I I I I I I fL r9C- ! <br /> r — - - - --- 12.� s i— —!��� 3 I 7 I X.i„ X i., ..,. . .--- --......rte <br /> I Mw$ I t Y I I I I I (c�(`A AC <br /> I !tit w q 1 1 Pd I I k !x 1 1 3 ! K I x l X 1 I I I I <br /> IRektncpished by (Signature) I Date/Time I Recet by (Signature) The following MUST BE completed by the laboratory accepting samples <br /> I O �-�' 1b q3 x:501 lh for analysis. 1 <br /> 1 Have all samples received for analysis been stored to Ice? I <br /> R t shed (S� at r ) <br /> hat me ReGelveil <br /> I �' by. (Signature) j <br /> 12 will samples remain refrigerated until analyzedI <br /> // !E /cam I •��� I <br /> (Relinquished (5t'gnatur, I Date/TimeI R v (Sign p re) 3 Did any samples received for analysts have head spaces I <br /> IV, <br /> ! s { 4 were samples in appropriate containers and properly packaged? I <br /> IReltnqukshLd by (Signature) I Date/Time I Rec by (Si nature) k I <br /> I I t 0M •aL-'DI <br /> I I Signature Title Date I <br />
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