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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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SHELL OIL COMPANY l CHAIN OF CUSTODY RECORD DafO. lo-1D- Isi <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Sorial No. c-i5 o%6- 1 Page I of 4- <br /> 511e Address: <br /> 420 iCettleman Lane, Lodi Analysts Required LAB: _OFn- <br /> WICm. 204-4416-0202 CHIC1(ONF(1)SOX ONLY C1/01 TURN ASOUNeTIMI <br /> Shell Engineer: Phone No • (510) c W 1.ion40flny ] inti <br /> 24 Aeon ❑ <br /> Daniel T. Kirk 67f-614? $10Inraftled1on ❑ aul 40 how, ❑ <br /> Consultant Name& Address Fax # 6-15'-4160 0 SoYCtaaulfy/DMposal ❑ 41t7 Uclays �(Noarnor► <br /> Blaine Tech Services, Inc m <br /> 985 Timothy Drive, San Jose CA x '"°�" au3 <br /> of C1a�sYy/prrpasal ❑ Moo ❑ <br /> Consultant Contact. Phone No . c40g) Q m <br /> Fran Thie `fqs- ST3S N N co � O am R�moiiy� ❑ us7 <br /> Fax #. �4 - )T O of +n NOrt Holurlob <br /> (� Q Wd.r norm of Sys loan as►oulbf. <br /> Comments: N `r O&M ❑ JIM 24149 Aft (Ar <br /> U a Z Olhral ❑ <br /> Sampled by: Q 0 ° o } <br /> �___ <br /> q a o '^ '� o a) UST AGENCY: <br /> c <br /> SAMPLEPrinted Name: a <br /> X Y aCMATERIAL <br /> NO °ia CONDITION/ <br /> m oSam le ID Dale Sludge Soil Water Ali m U DESCRIPTION <br /> conic U <br /> U COMMENTS <br /> 30 VA?- NaA TLME <br /> FI=CI4-CUI.IFOt?M <br /> ML '5 X 3 <br /> K <br /> l' Da a 2)Y/ 5 Time Initials <br /> x <br /> Ye �- Na Initial <br /> aA- <br /> X <br /> u <br /> pup <br /> Ta x Z >< <br /> it linqulshe y(5junature): hPhiln <br /> Nome. 5 Dale R atad Wgnaiur Pil d NGTQ ` Date. /0/-,/ 9 <br /> T1- �>� me J� <br /> 'Rollashe By(s1 alula). N e. � Tame O o e) P It,d Na D0 e <br /> ! /Y�/I <br /> Roll ulshed By(signature). Name. Dale Ra (sl elute) Ninled Name. Dale. <br /> Tlma AireTHE IABORATQRY MUST PROVIDE A!;Qey Qf J1111 CIIAIN-Of-CWTODY WITH INVOICE AND . <br /> 12 &W ft ChA.1C+.r+I <br />
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