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ARCHIVED REPORTS_XR0004131
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_XR0004131
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Entry Properties
Last modified
2/12/2020 3:28:38 PM
Creation date
2/12/2020 9:08:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004131
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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Advanced CHAIN OF COSTO ,RECO <br /> � <br /> _ = GeoEnvironmental, Inc. Date I?-z Lam. Page ` <br /> 837 Shaw Road Stockton, California- 95215 (209) 467-1006-f=ax (209) 467 1118 } 4 <br /> Client --.�r4 � �, Pro ` (N4 — Tests Required <br /> Pe N uber i --- <br /> ..,; I 1 <br /> 7'er, (Sig ure �� i QWCProject Name :ile+"IF <br /> f <br /> Sample Type <br /> Sample Location Date Time Water Soled I No of Notes <br /> Description I Comp Grab Air CorttS ,' l �` / <br /> Au <br /> �j G <br /> i <br /> j ! i <br /> I , <br /> E <br /> i <br /> i <br /> f <br /> I f <br /> i <br /> e in ulsy rg u } Received y (Signature) laatR,r�s <br /> `� <br /> Relinquished by ( Ignature) Received by (Signature) _ <br /> Relinquished by (signature) Received by Mobile laboratory for field analysis (Signature) Date y1dnf <br /> t <br /> Dispatched by (Signature) Date/Time Received for Laboratory by e—) `. DatefT�ms <br /> Method of Shipmentr <br /> -` Labor Name T�� <br /> `i, r _ <br /> Spectral Instructions 1 her x authorize tfieerform of the above IndicatedI, ti <br />
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