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ARCHIVED REPORTS_XR0004206
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_XR0004206
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Entry Properties
Last modified
2/12/2020 3:28:34 PM
Creation date
2/12/2020 9:15:13 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004206
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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� Advanced <br /> CHAIN of CUSTODOECORD <br /> --_= ,. -god GeOEnvironmental, Inc. Date ' V o 5 Page of <br /> 837 Shaw Road- Stockton California-95215- (209)467-1006- Fax(209) 467-1118 <br /> Client 10. (;(A twig <br /> Project Manager Tests Required <br /> Cir LLAk <br /> Phone Number <br /> D � Vo ? - /006 <br /> Samplers (Signature) Q Irnrolce <br /> Project Name AGE <br /> ' Qent7 <br /> Sample Location Date Time Waterpie Type Solid No of �t� k,� Q Notes <br /> Number } Description Samtromp Grab Air Conts (+� <br /> ^ lr If <br /> sI <br /> G7 —� v t! +t 0 Q <br /> ii it r] <br /> � -7 i t A#- )5 -t* 5 x <br /> 5ait to A. o Y <br /> Z5ii it illi of 55 I` <br /> 00 <br /> 35 �� •� i' „ <br /> At <br /> e q7usS e y ignature) Received-&-y- (Signature) Datefrime <br /> r <br /> 'S T /tt 1 r. Q I'<i a <br /> Relinquished by (Signature) Received by (Signature) DatelTims <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) Date/Time Recarvsid for Laboratory by 1-1/ Date/Tom <br /> i—J—Ct— <br /> Mfethod of Shipment Lab 7011ory Name <br /> C Vc nt,' tqL. c <br /> Special Instructions I hereby authorize the performance of the above Indicated work <br /> I <br />
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