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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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f• � � i• !, � t• � � t! � ftf� � ti: tttttttti � s� <br /> • i <br /> CHAIN OF CUSTODRECORD <br /> t Advanced <br /> GeoEnvironmental, Inc. Date �a�e — °�� <br /> 837 Shaw Road-Stockton, Callfornia- 95215-(209)467-1006- Fax (209)467-1118 <br /> Project M er <br /> Client �� °l Tests Required <br /> Phone Number <br /> 'Z--JJ 9 - —1 0 <br /> Samplers (Signature) Invoice* <br /> Protect Name (� ,.� AGE <br /> Client ❑ <br /> Sample LocationSample Type No of <br /> Number Description °ate Time Water Air - Solid Conts No's' <br /> comp arab 83361 <br /> 83362 <br /> 833fi3 <br /> �► x �C 83364 <br /> _-7 83365 <br /> - y_ �► �l 83366 <br /> I <br /> AefiThed by ignature Received y (Signature) DatelTime <br /> to I L0Z0 <br /> Relinquished by (Signature) Received by (Signature) ate/'rims <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) ST QT Datefrime <br /> T11 <br /> Dispatched by (Signature) Datelrirne <br /> Soceiv fQr Laboratory by te(frme <br /> Y�Lk-" �-. <br /> q <br /> Qy�Q( <br /> Method of Shipment I Kii Laboratory N7"Cd"'411\400 <br /> Special instructions I hereby authorize the pe formance of the above indicated work <br /> C,000 <br /> HUD SPAtC,-tABSWE1J1fl <br /> I S� <br />
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