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ARCHIVED REPORTS_XR0004200
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_XR0004200
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Entry Properties
Last modified
2/12/2020 3:44:36 PM
Creation date
2/12/2020 9:12:13 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004200
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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aea>, a_ ettet� etttttttt� �■■ �� tittttttttii tttttttttti• � ti• ti• � te♦ � ii � � <br /> CHAIN OF CUSTODRE <br /> � Advanced CORD <br /> GeoEnvironmental, Inc. Date - 2- f 14' Page of <br /> 837 Shaw Road -Stockton, California- 95215-(209)467-1006-Fax (209)467-1116 Q f /� <br /> Client Project Manager I Ip <br /> P� Tests Required <br /> I , CvA LLA <br /> Phone Number <br /> 6' 46 7 <br /> Samplers (Signature) Invoice <br /> Project Name � u � � AGS <br /> F)AvvNL ml,11, N) r l Client ❑ <br /> Sample Location Sample Type No 1 <br /> Number Description Date Time Water Air Solid Con sf v Notes <br /> Comp arab <br /> 1nW� - �5 5r �I s S � ' q- <br /> /r rl rI <br /> Mw5-7,42 r+ T z5 4 `1 '�l 12 <br /> VV) T 1 , 15 x <br /> v.}, 35 it Al35 �- `1`,2 14 X <br /> elinquis e by (Signature) ecerve y ignature <br /> � DatelTime <br /> Relinquished by (Signature) Received by (Signature) Date(Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for Heid analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Time Recewed for Laboratory by Date/Time <br /> f",&��Z' i- <br /> Method of Shipment Laborat Name <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br /> i <br />
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