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ARCHIVED REPORTS_XR0011764
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_XR0011764
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Entry Properties
Last modified
12/6/2019 5:01:17 PM
Creation date
12/6/2019 3:05:23 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011764
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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Phone (916)535-0200 APEX ENVIROTECH, INC. Send results to: <br /> Fax (916)535-0207 <br /> Sample Identification/Field Chain of Custody Record 32Apex EnArolech, Inc. <br /> g0 7844 Madison Avenue <br /> �,�uwe e�Y", cl,�, � ��fi S qj �� S` Suite 106 <br /> Site Address: q'i`�`r � Fair Oaks,CA 95628 <br /> Apcx Project#; Q Z, t �� <br /> Shipped May: 41.1 �n wt/ <br /> Shipped To: PSS e- eG n s c —_- _ lflazardaus Materials Suspected? <br /> Project Manager. l (4,1 / �____ ❑ Yes [ , No <br /> 4 Sample No.of <br /> Sampling Point Location field IDD Date Type Containers Analysis Required, <br /> P r <br /> JAI <br /> htv-9 <br /> V` <br /> i�w Y <br /> , r <br /> r i <br /> � r <br /> . � ` W V <br /> Sampler(s)signature: r� <br /> Field ID Relinquish4 by(signature) Received by(signature) DateJrime Comments <br /> Sealed For shipment by:(signature) Daie[Tirne: }!i (. Z • Ci��1 Shipment Method_ f' <br /> Recaved for Lab by:(signature) {}. Date[Firne: '�I1We-1 comments: r <br /> Rectiving Laboratory: Please return original toren after signing for receipt of samples. <br />
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