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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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I <br /> SHELL OCL COMPANY - CHAIN OF CUSTODY RECORD Date <br /> RETAIL ENVIRONMENTAL ENGINEERING -WEST Serial No _ Page 3 o1 "5 , <br /> sltB AddressL 2b, lU 4 _r'S :�LL�r/Tt cr � -- Analysis Required --- — – -LAB S_ y–------ - <br /> W ICS — CHECK ONF 111 BOX ONLY CT10T TURN AROUND TIME <br /> z�� `j`� 110 .�r_ L- _ O W Manloring U 4461 - ------ <br /> Shell Engineer Phi a ND :> �� 24 hau. LJ <br /> }��rL�) She lnvestlpallon 'R(1 4141 <br /> El <br /> Fax # '4 '> (cdf salt CtassuylUsposaa El 4442 <br /> 48hbus <br /> Consultant Name&Address Lira C Water <br /> 15 days {NormaE) <br /> �1 r <br /> Z/y� �2 y� °p ClassllylDlspbsal ❑ 4449 <br /> Other <br /> �Ly� t �l � { -- <br /> ConsRani onia Phone No 9, SoWNr Rain,or Sys <br /> �TS.� H m O&M t_l 4452 <br /> 04 <br /> Fax# 3'r. tw S U' 0 m ca m Wber norm or Sys Hina as OTE oily Lla bas <br /> Comments o < O e M 1-1 4459 24148 hitt TAT <br /> 13 2 72 o_ Ul in to C4 n CIO Other (J <br /> Sampled by m o a CID ' mbUST AGENCY .�•� �nF• Ct, � <br /> E1 9 lii m — - <br /> to <br /> Printed Name w w Lu O_ n ----�--- -- -- - ---- <br /> MATERIAL SAMPLE <br /> '�' m DESCRIPTION CONDITION/ <br /> Sample ID Date Sludge Sail Water Air Noto <br /> of <br /> � � m >0 IT a -- _COMMENTS <br /> Aisher <br /> Z3Sl011atkJre)) <br /> Print _Nameale Ijr-sem cel 1310 rel- �� !1P.ae r, - - Time Pricy Neme ale Il ed(slgnalu Printedd NamieUale_ _ oA� _ _ Time <br /> PrlRted NName Date ecel^{sl nature r Me ati <br /> Time <br /> THE LAI3ORATO5Y MUST PROVIDE--W COPY OF THIS_CHAIN O CUSTODY_WITH INVOICE_ AND RESULTS _— <br /> �—""- StIELL nit COMPANY 4714AIN OF C{IS10nY <br /> REV 411199 <br />
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