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ARCHIVED REPORTS_XR0012470
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_XR0012470
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Entry Properties
Last modified
2/10/2020 9:23:00 PM
Creation date
2/10/2020 4:29:21 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012470
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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—F SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dare: 2O'P <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No: Page 4 of - <br /> Site Address: 4ZO w. Koffl elmn Lad.{- Analysis Required LAB: <br /> _c;AP k'aj SA�S CHECK ONE(T)AOY ONLY CI/01 TURN AROUND TIME <br /> (V%C tcLtK+�* 9S )ac55z-5 W <br /> y,,,_ I o W. Mondorinq ❑ "+t yA hours ❑ <br /> $hell Engineer: Phone No.; F <br /> t559D L.4S-9�� ,�, sn•Inresrlpallon 0 uAt Aa haus ['] <br /> K,r,�,vi Lc�h Fax 0• wjftfa o W <br /> Consultant Name &Address: N sonclar�rry/olsposar E] ua� <br /> p � t5doys (N <br /> orman <br /> CAIS l5jtiA c-NVIRoNMN <br /> ETA-L. L. 1-�Nr11.C�i1 � �C• CK) wale <br /> .1�. 130K N2, S206146CA "7 Clmeny/Drsporal ❑ /AAS other ❑ <br /> Consultant Conlacl: Phone No.: , N SonlAlrAaRatSys AAs: <br /> C"*fn)995-4859 ,, y co cd �•• o a M ❑ NOTE- Nancy lab as <br /> A u5KEY COOL— Fax 9'hm)ow.640 Da Water Rem,or Syr ❑ US3 roan as Fallible of <br /> o a M <br /> Comments: D v m <br /> WAS his TAI <br /> 0 0 Zo U Olh+r ❑ <br /> C) C N M 1 <br /> Sampled by: A� ,��� o o � rn a. o ;n c UST AGENCY: <br /> 0LIP °' SAMPLE <br /> Printed Name: w W o 0 m a C MATERIAL CONDITION/ <br /> Tir+� No of x a� a a U DESCRIPTION COMMENTS <br /> Sample ID Dale Stl9 Sail Wale[ Air conic, 1'' � y U a U <br /> 1130 — �P <br /> -2,D. s' 1\3.5 4-toL <br /> SIB -3 — <br /> 2S CS i1#3 <br /> '��3 3 — <br /> 166) <br /> M-00 X <br /> )2,DS <br /> Racely d(s1g re}, Prl�w amt. � Dala: 1 <br /> Reil quis ed By(s gna we - �} Prir ed Name Dale:2- nme! I <br /> fl'C. C-� , <br /> Urn s n �6) PTlnled Na Date, R v sl nal P d am q le� <br /> r� 4 Gr d lime: �'?` - Do a: <br /> RelfTtquished By(siQnalute): Ptlnled Name: Drrl — R elved(slgnaiure); printed Name: Date: <br /> Iime: Elmo: <br /> -CUOD g <br /> nwpW►1 �eor <br />
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