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ARCHIVED REPORTS_XR0012692
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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F
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F
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5491
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3500 - Local Oversight Program
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PR0545028
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ARCHIVED REPORTS_XR0012692
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Entry Properties
Last modified
12/6/2019 5:54:55 PM
Creation date
12/6/2019 2:59:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012692
RECORD_ID
PR0545028
PE
3528
FACILITY_ID
FA0003919
FACILITY_NAME
VAN DE POL ENTERPRISES
STREET_NUMBER
5491
STREET_NAME
F
STREET_TYPE
ST
City
BANTA
Zip
95304
CURRENT_STATUS
02
SITE_LOCATION
5491 F ST
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
Scanner
SJGOV\wng
Tags
EHD - Public
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Jill <br /> ,EARTH <br /> N+c <br /> T <br /> T EAISL <br /> L� C'(11u�U�.TAN t turn- around <br /> ENVIRQNMENTA <br /> PROJECT NAM: <br /> CHAIN OF CUSTODY RECORD <br /> _ . <br /> ioZ <br /> SAMPLER (slgnatuCe) : Nwiiber of �^Ny'Y��,a <br /> a,� Containers/ r �� p <br /> o, ti <br /> Type of 4� �5' GoFc <br /> Date Time Sample Location Sample <br /> a8:roSa''AAsa 8s <br /> Lab J.D. <br /> w a, <br /> — <br /> t <br /> Relinquished by: Date / Time Received b : RelinA -aqu's�ed by: nate Time <br /> i• Qfy / Received bye. <br /> �•i�•s:•1 I��.-a ,�{�,� s„ ,� �• <br /> r'rrti �I Y.r L <br /> Company: ' Com an : �� //C"--o""-m an '!�` �.� ��;{,��� t,-•r.3-L•S- <br /> Relinquished by: Date Tlme Received b •� y Company:eby. <br /> y: Relinquished by: Date—/—rime Received by: <br /> _Company: <br /> Company: Com an : <br /> Relinquished by: Date COMany: <br /> :Time Received by: Relinquished by: Date Time Received by: <br /> Company: <br /> Com2any Company. <br /> {' Company: <br /> 1 NOTE: In preparing legal documents always use ink and signatures <br />
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