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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 /> t <br /> *Advanced YOCORD <br /> GeoEnvironmental, Inc. Date 49 2 Page S of <br /> 4005 North Wilson Way-Stockton,California-95205-(209)467-1006-Fax(209)467-1116 y <br /> ClientL Project Mame,—. <br /> C���~-cam <br /> Tests Required <br /> Phone Number <br /> Samplers {Signature), Invoice <br /> Project Name r �' AGE <br /> Z/ -7Z� Client ❑ <br /> Sample Location Sample Type No <br /> Date Time Water Air Solid Contsf Notes <br /> Number Description � <br /> Comp Grab <br /> 2 l9/y 7 'a /d 22156 <br /> Z �ISf /11601 221570 <br /> Z ZS P35 / 22158 <br /> Z- 3o Zra3 f 22159 <br /> 7,Z- r 4221 6o <br /> 221619 <br /> Relin- e y ignalup) <br /> ace ve y (Signature) g7 � ' [late/Time <br /> Refinquiefe by (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Received for Laboralory by <br /> Date(Tlme <br /> Method of Shipment /7 M © ,��� Laboratory Name <br /> (uu'rr�(/� (//r G CLei2Q: LA-6 S <br /> Spacial Instructions plelp'�e- <br /> / 0 I hera6 authorize the <br /> y1�1 Y performance o the above Indicated work <br /> A <br />
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