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ARCHIVED REPORTS_XR0011828
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_XR0011828
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Entry Properties
Last modified
12/6/2019 5:16:33 PM
Creation date
12/6/2019 4:34:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011828
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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I <br /> CLS - Labs CHAIN OF CUSTODY CLS ID No.• o2s <br /> � - " LOGNo.11759 <br /> REPORT TO: CLIENJRA <br /> MAN'A REQUESTED FIELD CONDITIONS: <br /> NAME AND ADDRESS <br /> ra� � �DESTINATRYCLS 301 ROJECT MANAGE PHONE# 3249 FI .RANCHA. COMPOSITE: <br /> PROJECT NAME5742 <br /> SAMPLED BY �L 4' ❑ OTHER C �, <br /> JOB DESCRIPTION <br /> firfi � <br /> SITE LOCATION I K TURN AROUND TIME SPECIAL INSTRUCTIONS <br /> DATE TIME SAMPLE CONTAINER o `�'o q o <br /> IpENTIFlCATI MATRIX NO. TYPE <br /> 1� 3 <br /> a <br /> 4 <br /> INVOICE TO: <br /> P.O.# <br /> SUSPECTED CONSTITUENTS QUOTE# <br /> SAMPLE RETENTION TIME PRESERVATIVES: (1)HCL 0)=COLD <br /> ELIN HED BY SIGN (2)HNO, (4) <br /> ) PRINT NAME 1 COMPANY DATE/TIME RECEIVED BY(SIGN) PRINT NAME/COMPANY <br /> UAr —A e,6 (c ao to <br /> RECD AT <br /> DATE/TIME: CONDITIONS/COMMENTS: <br /> SHIPPED k_ ❑ FED X ❑ UPS ❑ OTF;" AIR BILL# <br />
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