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ARCHIVED REPORTS_XR0003625
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_XR0003625
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Entry Properties
Last modified
2/10/2020 4:55:08 PM
Creation date
2/10/2020 4:12:19 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003625
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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Aft <br /> SHELL OIL COMPANY W CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING -WEST Serial No Page I of 3 <br /> Site AddressAnalysis Required LAB <br /> _ l/ fel l�a.tea , <br /> WIC# C1IECKONE it)BOX ONLY CT/DT TURN AROUND TIME <br /> Zdtt -44 /b <br /> i 4 W Monloiing ❑ Oast <br /> Shell Engineer Phone No S(D Site Investgatlon 4441 24 hour ❑ <br /> h,,L k I Fax 0 ri Sol ClaseltyANsposal ❑ 4442 40 noun ❑ <br /> Consultant Name& Address rJ/�7 ��f a <br /> `r f`' O water 15 days )KINorma]i <br /> � �c0Me� f,1 � L �e- 4 m Clasellylpleppeal 1-i 4aa3 <br /> Other 0 <br /> Cof~i`sultant C nlaclPhone y[6 -� solm,rAJr Reor By* <br /> (j, ,�, Lxr� z-7�!`��' 1I� $ CIO 0 a M [1 4452 <br /> Fax N TJ`y ro LD co °d NOTE Nortly Lab as <br /> Winer Aem a Sye <br /> ❑ N Soon a4 or <br /> Comments }' n O W O s M ❑ 4463 24148 Met TAT <br /> TAT <br /> Other ❑ <br /> Sampled by u' 'n N E `� z m <br /> F✓� ¢ M C r UST AGENCY f r -l' C <br /> w co <br /> ¢ ¢ d E' p .. o <br /> a.Panted Name Ujj w MATERIAL SAMPLE <br /> Sludge No of x x m (4 E c m E DESCRIPTION CONDITION/ <br /> Sample ID Date Si ge Sod Water Air cants 0Q COMMENTS <br /> I�tiw <br /> -6 K, <br /> 8 �R a <br /> _1 - — — ---- oa-R3 <br /> /JA (/614 - 1� of <br /> MUM - Z _ _ _ ()d-q5 <br /> .rt'' <br /> — _ ILI co-9g <br /> ReLngr d S e) Print ama ) Date $-S S� A elved sig e) Prl ed a e Daie ,,rte <br /> — DS La 1 r j^ Time �(1(�� me <br /> Rall qui y Ignature Prlpte Name Date^ R r Is nature Printed Name Dale <br /> I()/.,)X-// Time Sty Time <br /> nquishe y(signature) Printed Name Dale el Signature Printed Date <br /> Time:: �: _it� Time d <br /> THE LABORATORY MUST PROVIDE A COPY OF THIS HAIN OF C WITH INVOICE AND RESULTS _ <br /> REV 411193 — �� SHELL OIL COMPANY CHAIN OF CUSTODY <br />
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