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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
Tags
EHD - Public
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A <br /> COOLER RECEIPT FORM <br />:)r�ct: �l� �Zti og No: �, <br /> c r receive on: an checked on b <br /> \ igna ure <br />+sere custody papers present? . . . . . . . . . . . . . . . . . . . . . . . . : £1' NO <br /> Were custody papers properly filled outer . . . . . . . . . . . . . . . . . . YE NO <br /> Were the custody papers signed . . . . . . . . . . . . . . . . . . . . . . . . .mss NO <br /> Was sufficient ice used? . . . . .-Y-ES NO `ELVR <br /> Did all bottles arrive in good condition (unbroken) ? . . . . . . . YZ& NO <br /> Did bottle labels match COC? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y-Es NO <br /> Were proper bottles used for analysis indicated? . . . . . . . . . .X-S& NO i <br /> Correct preservatives used? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 't 's NO <br /> VOA vials checked for headspace bubbles? . . . . . . . . . . . . . . . . . .SFS NO <br /> Note which voas ( if any) had bubbles: * <br /> Sample descriptor- Number of vials: <br /> *All VOAs with headspace bubbles have been set aside so they will not be <br /> usedfor analysis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .YES NO <br /> List here all other fobs received in the same cooler: <br /> Client Jab # __ NET _lo <br /> Fyan <br /> Pe Com! Co <br /> (coolerrec) <br />
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