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ARCHIVED REPORTS_XR0004134
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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KETTLEMAN
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1301
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3500 - Local Oversight Program
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PR0545342
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ARCHIVED REPORTS_XR0004134
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Entry Properties
Last modified
2/12/2020 3:48:03 PM
Creation date
2/12/2020 9:08:48 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004134
RECORD_ID
PR0545342
PE
3528
FACILITY_ID
FA0000392
FACILITY_NAME
FLAMES LIQUOR
STREET_NUMBER
1301
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95242
APN
03104030
CURRENT_STATUS
02
SITE_LOCATION
1301 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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i 0 i ' <br /> t Advanced CHAIN OF <br /> CUSTODY RECORD <br /> -__ GeoEnvironmental, Inc. Dace page _ <br /> 837 Shaw Road-Stockton,Cahfornta 95215-(209)467-1006-Fax (209)467-1118 , y _ fi '4 L1 <br /> Client <br /> `' r4 ' P«act'Mana9 Tests Regtrlred <br /> Phope Nuytber <br /> lad- <br /> s <br /> _S (Sig e) ' invoice <br /> � ' / /!� <br /> / / bGE <br /> � x�4, / <br /> rProject Name l � / ��/ � <br /> Sample Type / <br /> Sample Location Date Time Water Solid No o! � r / Names <br /> Number Description CAir Corns <br /> omp Grab ^"{7] <br /> M 02 -2 1--C(2- 'V kil <br /> 3 <br /> e ma ig at a Received y ,gna ure D eLTin <br /> JA fit, '& r <br /> Rslen u,ahed by'(Signature) 1 Received by (Signature) atelTime <br /> U <br /> Relinquished by Received by Mobile Laboratory for field analysis (Signature) Dalef rime <br /> Dispatched by (Signature) Datefrfime Received for rafoiy by Datef7ime <br /> y � P <br /> Method of Shipment del F,)t)e r,�,J t C Labors ame <br /> - - <br /> Special Instructions hereby auXfibtr ze the rtorm nce of the move indicated work <br /> r <br />
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