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ARCHIVED REPORTS_XR0004202
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_XR0004202
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Entry Properties
Last modified
2/12/2020 3:14:46 PM
Creation date
2/12/2020 9:13:15 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004202
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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• <br /> ( = = = = = = = a& IMI <br /> Advanced CHAIN OF CUSTOD ECORD <br /> Date l� �� Paye of <br /> GeciEnvironmental, Inc. <br /> 837 Shaw Road - Stockton,California-95215 - (209) 467-1006 Fax (209) 467-1118 <br /> Client Poject Manager Tests Required <br /> umber, , <br /> ,Phone2-0q L6 C)6 <br /> Samplers (Signature) Invoice <br /> � AGE [.� <br /> Project Name Client E] <br /> Sample Location Sample Type No of �L �� <br /> p Date Time Water Solid '� Notes <br /> Number Description comp Grab Air Conts <br /> I <br /> x <br /> LtlM�t t k 6103 <br /> ; it tk�t; �e Ix jt X <br /> k kLko 3 M1rV V t1�ltE'aS lc X <br /> Acv lr ti-to-3 <br /> Relinquislied by ignature Received by ignatura Dat0 Ime <br /> Relinquished by (Signature) Received by (Signature) Dat (Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysts (Signature) ��TA Datefrime <br /> Dispatched by (Signature) DatalTlnte Received for Laboratory „ / Datefrims <br /> �1 Qi==LJ `�_ -3 ', <br /> Lab ory e <br /> Method of Shipment <br /> V <br /> Special Instructions �� { I hareb uthonze the per encs of the above Indica9d ark <br />
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