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ARCHIVED REPORTS_XR0004126
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_XR0004126
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Entry Properties
Last modified
2/12/2020 3:43:40 PM
Creation date
2/12/2020 9:05:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004126
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 F CUSTOD <br /> ( Advanced YOCORD <br /> ----�`;'� GeoEnvironmental, Inc. Date © Z3 Page Z of <br /> J <br /> 4005 North Wilson Way-Stockton,California 95205-(209)467-1006-Fax(209)467-1118 f` & 1 I r <br /> Client v�12 Project Marta Tests Required <br /> Phone Number O'er <br /> �J 4(,-5,? <br /> Samplers (Signature) ��80 Invoice <br /> Project Name N� Q AGE <br /> Client <br /> Sample Location Date Time Sample Type No of <br /> Number Description Water Air Solid Conts �� Notes <br /> Camp Grab <br /> +7U 0' 22149 <br /> 22150 <br /> 22151 <br /> 22152 <br /> 221531+ <br /> 31 <br /> >n1 l 1 Z:3D 5 va► 22154 <br /> }Z S J9Y-)^r '0-4z_ 22 155iiA <br /> e in is a y n ure ece ve y ignature) `7f�S�`��i Dateltime <br /> �V� z S=D �� .T z �9 3 v� <br /> elmqui d by {Signature Received by (S�gnature) Date(T1me <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatetTlme <br /> Dispatched by (Signature) Dateffime Received for laboratory by Datefrime <br /> Method of Shipment � s,� laboratory !Name <br /> Special Instructions 1 V 1 hereby authorize ti, parlor nce of the above Indicated work <br />
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