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ARCHIVED REPORTS_XR0004123
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_XR0004123
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Entry Properties
Last modified
2/12/2020 3:10:47 PM
Creation date
2/12/2020 9:04:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004123
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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� i• i• � I• � � I• i• � � i• t;i t;i t� tip tttttttt� tiitiiiit� <br /> CHAIN OF CUSTODY�NEQ <br /> Advanced <br /> , ! �� �, ? r.�>- <br /> GeoEnvironmental, Inc: - ,� �i� Date 1f Page --I— of <br /> 47b-iYer1Stockton,California-95205 (209)467 1006-Fax(209)467M 18 <br /> LV <br /> Client �l Project Manager, Tests Required _ <br /> Phone Number <br /> )- --` t, 7 <br /> Samplers (Signature) Invoice <br /> AG E <br /> Protect Name Client ❑ <br /> Sample Type <br /> �` <br /> Sample Location No of ,>�. '� ,;;� <br /> Number Description Date Time Water Air Solid Conts /., ,�;�' T Notes <br /> Comp arab 6168V <br /> 61 86 <br /> G It , 't � ao -V\ . <br /> Ro rt X61689 <br /> e mq s e i nature eras ve y pnature Date/Time <br /> inr0 -UG-0 63ci <br /> Relinqu ed 15y S gnature)M Received by (Signature) DatelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for tleld analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Rd�eiixefi fort~ a orator by DatelTime <br /> 1 <br /> Method of Shipment JJ Laboratory Name ! y <br /> Special Instructions <br /> I hereby authoflze'the performance oflthe above indicated work <br /> V � <br /> G <br /> 10Er} ..� PREMATIOPFROPOTE <br /> , <br /> HEAD SPACE ABSFNT <br />
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