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ARCHIVED REPORTS_XR0003624
Environmental Health - Public
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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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420
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3500 - Local Oversight Program
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PR0545336
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ARCHIVED REPORTS_XR0003624
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Entry Properties
Last modified
2/10/2020 4:46:25 PM
Creation date
2/10/2020 4:11:51 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003624
RECORD_ID
PR0545336
PE
3528
FACILITY_ID
FA0003776
FACILITY_NAME
KWIK SERV LODI BW 113*
STREET_NUMBER
420
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
06202042
CURRENT_STATUS
02
SITE_LOCATION
420 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD D°te• <br /> Pa <br /> �-Ir�12s� -�'� <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No: 9e ! of I <br /> Slle Address: 420 Kettleman Lane, Lodi Analysis Required LAB: � <br /> "Cl: 204-4416-0202 CHECKON14090xOHIY Cilni IVRNAMOVNb11Mt <br /> R]Ekk G W. I+lanlaln4 r] oil 7t boon ❑ <br /> Shell Engineer: P. Jeff 4n, Rhone No.- ('510)) <br /> • 675'-6/68 Uslnrsengdbn ❑ 4"1 46 bows ❑ <br /> Fox P. 67s- &0 01 <br /> Consultant Name& Address: [� s"'C'O"wro�Aoaa1 ❑ ``a' 16 day. ]("Ot"104 <br /> Blaine Tech Services, Inc. to wd., <br /> 985 Timoth Drive San Jose CA o Uj Cl "43CIMOY/Okp"01 ,s Olhsr ❑ <br /> Consullanl Conlacl. Phono No.: C40-0) = a m ssalrArRnnor:rL 44si7 <br /> Fran Thie Fax M•qv-a31 T7 °1 go ad oahs ❑ HomNow tat <br /> Comments: In N 06 ROM*ISM soon24/4 $i/o AL <br /> o a t`14 ❑ 4467 Za/4s i,ti 1A1 <br /> m <br /> O 0 a 11 W Z Olhef ❑ <br /> Sampled by: .�____� — Q o m of o. o N o a UST AGENCY: <br /> CO '° 4 O <br /> Prinled Name: � � �, 1 Q a a c o C `^ <br /> w m o p N do p- MATERIAL SAMPLE <br /> x (: a a CONDITION/ <br /> No of x Z w N A 0 a o DESCRIPTION <br /> Sample ID Dole Sludge sou Wolof Ali a ►- ° m ° `" o COMMENTS <br /> conts r as > r- U d U U <br /> (CjQ3 <br /> ��►-4 11ri3 w � x P`'" �'T1"`' � <br /> STODY MAU <br /> Dey <br /> EAL INTACT? <br /> No <br /> ._.�_ lnitfal <br /> RR4h}qulshvd�(Isllglnlchuo). Pifnrad Namo. Dale. o d pnntui Pa Nymo. Dole <br /> Tf t'.�LSAO ills t?O �j� ' <br /> P(Int Name. Dale C g to : Pt d Na Da o• <br /> lime ilme. r <br /> IRKnqulMedl 6y(slgnahlro). Prlilled Name Dale o a gn tufo) Prinled Horne. Dale- <br /> Write: <br /> nnw: <br /> lilt 1AB0RfflQ OPY OF 1111;C1IAIH-QF-CU51QQX WITH INVOICE A Q RESUILIS <br /> "VIA 'I'V(5 <br />
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