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ARCHIVED REPORTS_XR0011795
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_XR0011795
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Entry Properties
Last modified
12/6/2019 5:12:18 PM
Creation date
12/6/2019 3:45:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011795
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
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SJGOV\wng
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EHD - Public
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IJV 95 <br /> California L-�;�;joratory Services CHAIN 0 F CUSTODY , CLS ID No.: 13 LOG NO. <br /> REPORO: FIELD CONDITIONS: <br /> T T <br /> ADDRESS <br /> MADISJA DESTINATION LABORATORY <br /> -j Avc M <br /> 0"5rl(-" 'm CLS (916) 638-7301 0 <br /> PROJECT M GER <br /> PHONEM 3249 FITZGERALD Ra m <br /> LA we HtL RANCHO CORDOVA, CA COMPOSITE: <br /> PROJECT NAM%(LS 95742 < <br /> pt <br /> -TfLoLcUm <br /> SAMPLED BY ❑ OTHER R <br /> NJOB DESCRIPTION (1) <br /> ZZ, <br /> I.-.TL AR .UNP.T11 E i': SPECIAL INSTRUCTIONS.: <br /> SITE LOCATION <br /> >g '>'i >g <br /> DATE TIME SAMPLECONTAINER <br /> IDENTIFICATION MATRIXN0. TYPEMIA C2� 1 S <br /> 6%oo Gi P-5@ ki I PAnc F3P T <br /> N 15, GP- Is-, <br /> p� Y-) <br /> INVOICE TO: <br /> P.O.h <br /> QUOTE 0 <br /> SUSPECTED CONSTITUENTS SAMPLE RETENTION TIME PRESERVATIVES: '(1) HCL (3) = COLD <br /> J2) HNO3 <br /> (4) <br /> RELINQUISHED BY(SIGN) PRINT NAME I CdMPANY� RECEIVED'BY(SIGN) <br /> OW I TIME:,i. <br /> PRINT NAME COMPANY <br /> T <br /> (d 11 - 79 <br /> RECO AT E I CONDITIONS j COMMENTS: <br /> SHIPPED VIA D/<ED X UPS OTHER AIR BILL # <br /> -------------------------------------------------- ------ - <br />
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