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ARCHIVED REPORTS_XR0004136
Environmental Health - Public
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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_XR0004136
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Entry Properties
Last modified
2/12/2020 4:18:17 PM
Creation date
2/12/2020 9:09:30 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004136
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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I <br /> Advanced CHAIN OF CUSTO ECORD <br /> � <br /> GeoEnvironmental, Inc <br /> Date � ��3 �P� _J_of 2L <br /> 837 Shaw Road- Stockton, California-95215 - (209)467-1006 Fax(209) 467-1118 <br /> Client �- fir, i' rr Project Manager Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> AGE <br /> Project Name [7o4� <br /> Client ❑ <br /> Sample Location Date Time Weser Type <br /> Sold No of lye' Notes <br /> Number DescriptionComp Grab Air Conts - t <br /> i <br /> rA r FT <br /> 1' <br /> !r , <br /> � rr <br /> r( t Z� F <br /> �C r C ci f <br /> 3 - 35� � � '��, Ir IFL �9 ' 5s in uis e y ( igneture ece�ve yignaAure _ De (Time <br /> Relinquis d by (Signature) Received by (Signature) D telTame <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date[Tlme <br /> 3 <br /> Dispatched by (Signature) DatelTime Received for Laboratory Datelrime <br /> Method of Shipment L.a story <br /> I hereby authorize the performance of the above indicated work <br /> Special Instructions <br />
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