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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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i i i i � f♦ i � i i i � t♦ � t♦ � � � � <br /> Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmental, Inc. Date y-a1 0 q Page _L— of <br /> 837 Shaw Road-Stockton, California- 95215-(209)467-1006-Fax (209)467-1118 j [` <br /> Client &V-(J f- I q iA n- Project Manager f �p <br /> Tests Required <br /> Phone Number <br /> 7 <br /> Samplers (Signature) Invoice <br /> Project Name (� ` �� AGE <br /> 1 � Client <br /> Sample Location Sample Type <br /> Date Time Water Solid No of Notes <br /> Number Description Comp crab Air Conts <br /> L <br /> A 429 <br /> 0d9 <br /> el, Is e y (Signature ecerve y Ignature <br /> DatelTims <br /> y ",�] -V <br /> Rel n shed by (Signature) Received by (Signature) Date/Time <br /> S fJ <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Date/Ttme Received for Laboratory Date/Time <br /> I L�A)A-�Z �f- 2 _": 1, .� <br /> Method of Shipment <br /> OL ratory amev l�t <br /> Spectal knSITucriOne I hereby authorize the performance of the above indl &ted work <br /> i f� <br />
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