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ARCHIVED REPORTS_XR0004197
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_XR0004197
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Entry Properties
Last modified
2/12/2020 3:30:01 PM
Creation date
2/12/2020 9:10:40 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004197
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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� Advanced <br /> CHAIN OF CUSTOAECORD , <br /> GeoEnvironmental, Inc. Date 0-2(1-1105- Page —L of <br /> 837 Shaw Road - Stockton California- 95215 - (209) 467-1006 - Fax (209)467-1118 0 ) _ j IY <br /> Client .� Project Manager c_ I f <br /> Tests Required <br /> hone Nu ber <br /> Zo�t�-1-t - 1 -V0OC2 <br /> Sam p (Signature) Invoice <br /> Project Name AGE� Cherrt <br /> Type <br /> rV <br /> Sample Location P <br /> Dale Time SampleSolid Na of n' Notes <br /> Number Description Comp Grab Air Conts <br /> �uu ezr7©1 1 has l30 l � <br /> �3 CL40 X <br /> �kwq 10S-z 3 <br /> I �Aws 16Zv <br /> w 9W Ca (kka <br /> guy, 3 -,<jxFF , <br /> e I n4uished bf ( igna ecerve y ionalure Date/Time <br /> ZI-1aS <br /> Ra inquished by (sig re) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) � Date/Time <br /> I <br /> Dispatched by (Signature) Date/Time Received for Laboratory bDate/Time <br /> /01 ", Z—i to rJ <br /> Method of Shipment I 1 oratory�r <br /> Special instructions tP I here authorize a Performa ce of the above indicated work <br />
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