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ARCHIVED REPORTS_XR0004120
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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1301
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3500 - Local Oversight Program
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PR0545342
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ARCHIVED REPORTS_XR0004120
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Entry Properties
Last modified
2/12/2020 3:51:53 PM
Creation date
2/12/2020 9:00:19 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004120
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
Scanner
SJGOV\sballwahn
Tags
EHD - Public
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CHAIN STODOECORD <br /> t Advanced C NOF CU <br /> �t ° <br /> GeoEnyironmental, Inc. �g��� `t��-� Die Page —L of <br /> 937 Shaw Road -Stockton, Califorrna- 95215 -(209)467-1006 - Fax(209)467-1118 <br /> Client P� '; Project Manager Tests Reqtnmd <br /> Phone Number � <br /> -LDci-`f6-7 -loo <br /> Samplers (Signature) �ti Invoice <br /> Project Name �'} AGE <br /> ��\A\e �M\AA - J Client ❑ <br /> Sample Location Sample Type No of � <br /> Number Description Date Time Water Air Solid Coats /� t• •-- <br /> Comp (arab 3355 <br /> c - o10 8101 3IQ 83356 - <br /> r— —7 t` 1330 X <br /> 83357 <br /> C - 1 - 11 r` I'D <br /> C _Z_ 1 IS 3 x 83358 <br /> C, ,i \ 3 f- Y- 83359 <br /> e in is ey gnatura acerva y Fgna urs Date/time <br /> l lQa& `Z-a ZfJ <br /> Relinquish d bi (Signature} Received by (Signature) ��ryry Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) �1� Date[Time <br /> Dispatched by (Signature) DatelTlme lRecelved oc.Laboratory 0t /Time 3 <br /> 1� �-- !1 dct�ai 8 tK <br /> Method of Shipment Laboratory Name <br /> Special Instructions GOVU CUNDITfON V/ SE ON I hereby authorize the performance of the above indicated work <br /> HEAD SPA ZAPPRnppwr <br /> C -eoi On -7- b,W end l Jne. 1irnF, <br />
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