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Environmental Health - Public
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3500 - Local Oversight Program
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PR0545342
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Last modified
2/12/2020 10:31:20 AM
Creation date
2/12/2020 8:52:03 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545342
PE
3528
FACILITY_ID
FA0000392
FACILITY_NAME
FLAMES LIQUOR
STREET_NUMBER
1301
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95242
APN
03104030
CURRENT_STATUS
02
SITE_LOCATION
1301 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
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EHD - Public
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3 <br /> Advanced GeoEnvironmental, Inc. www.advaeoenv.cotn CHAIN OF CUSTODY RECORD <br /> 837 Shaw Road,Stockton,California 95215 •Phone(209)467-1006 a Fax(209)467-1118 Date:1'�2� I Z--Page � of <br /> I — <br /> r .,..• 381 Thor Place,Brea,California 92821 •Phone(714)529-0200•Fax(714)529-0203 C <br /> -" ❑2318 Fourth Street,Santa Rosa,California 95404 • Phone(707)570-1418 •Fax(707)570-1461 Analysis Required <br /> ❑395 Del Monte Center,#111,Monterey,California 93940 •Phone(800)511-9300 s Fax(831)394-5979 <br /> Project NULMg— t Project Manager } <br /> Client Sampler(initials&signature) <br /> I � <br /> Invoice to: GE ❑ Client Lab Project No.: 1 <br /> Sample IDlLocation!Description Date Time Matrix Number Notes <br /> 1 <br /> 1 I ' <br /> 1 <br /> ; I <br /> q bed by: Date; Time: Laboratory: P <br /> Courier: Received by: Date: Time: <br /> I <br /> Ri linquished by: Date: Time: Received by: Date: Time: <br /> i <br /> � I <br /> Relinquished by: Date: Time: Received by: Date; Time: <br /> -2— <br /> Requested <br /> R uested Tum Around Time(circle): 24 hours 48 hours 72 hours 5 d (stan and Other: Matrix Codes: A=Air W=Water S=Solid <br /> Special Instructions to lab: I hereby authorize the performance of the above indicated work <br /> Geotracker EDF to:71geotracker®advgeoenv.com D Global ID:. <br />
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