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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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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
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SJGOV\sballwahn
Tags
EHD - Public
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taw � � �� � � 1• i• � � i♦ � � t� � � <br /> � *Advanced <br /> CHAIN OF CUSTODY WORD <br /> GeoEnvironmental, Inc. Date 9 Z3 g Page i of ° <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467-1006-Fax(209)467 111 a ci <br /> Client Fzk'V 1 L-1-- Z-1'(1aaR Z-/'(1a <br /> Project Manager Tests Required <br /> 10- -04c-rC4 <br /> Phone Number <br /> Zoe `7 —/dr <br /> Samplers (Signature) Invoice <br /> Project Name AGE <br /> L �U� Client ❑ <br /> Sample Location Sample Type No of <br /> Date Time Water Solid f� 4� Notes <br /> Number Description Comp Grab Air Conts <br /> I <br /> e r�u s e ( nature ace ve y Tvanature � � � Da e/Time <br /> Cg3 <br /> Retmq ted by (Signature) Received by (Signature) ' ate/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dale/Time <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by Date rime <br /> Method of Shipment r Laboratory Name Mc <br /> /+ <br /> L <br /> Special Instructions � � � n J � it � { hereby authorize the parlorm nca al the above indicated work <br />
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