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ARCHIVED REPORTS_XR0011847
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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5491
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3500 - Local Oversight Program
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PR0545028
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ARCHIVED REPORTS_XR0011847
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Entry Properties
Last modified
12/6/2019 5:21:45 PM
Creation date
12/6/2019 4:36:37 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011847
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 /> SPARGE n TECHNOLOGY, INC. G CHAIN OF CUSTODY RECORD <br /> Ana►yticat Laboratory Phone:(916)362-8947 C.O.C. No. 2 5 3 9 3 <br /> 3050 Fite Circle,#112 Sacramento,CA 95827 FAX:(916 _ <br /> 362-0947 Page�„ of 2 STAL Invoice Number: x, <br /> Company: pQ-� Phone: ANALYSIS REQUEST <br /> Project Manager: f Lp'll"iam FAX: REMARKS: Sampler's Name: <br /> Report Address: Billing Name&Address: <br /> All None Some <br /> Project Name: rooriL eA 2✓✓A ;, ,, Project/Job#: OK OK OK WET STLC <br /> Cooler Temp. 0C <br /> Project Location: C%A,1,�, P0.#: Sample Condition TCLP <br /> r H <br /> Preservative TCLP Total <br /> Sampling Container Used Matrix TAT <br /> W . L <br /> F- co coN <br /> � C <br /> Ln 1 j r N dL' <br /> � N <br /> z <br /> U3 O <br /> aN N d 0GO <br /> a s a m <br /> LO IL <br /> 0 N U V LO <br /> o `n u0s d a Q L 0 U a <br /> Ql 0 U m N O N a00 a00 0 � � otS .o N N � � <br /> Q m - ro a� a 2 m m m � � � � m m 2 m <br /> O � - z d @ O O O O N N Q O V W <br /> -i �n E E .. X u c0 cD co (0 cD co 4 c o ro <br /> E <br /> @ u0i L U o L ro 6 _ H Fw 0. ii a d a< �a d o �` U Q ¢ `� 5 o <br /> NO. SAMPLE iD Date Time m N p r z O cn O m m w w w w w w ° z O o v c3 ca ¢ _ <br /> 1 tAUj - s I° Itis, <br /> 2 w-1 - J0 I <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> 8 <br /> 9 <br /> 10 Fr I <br /> Relinq r�hed y: Received Relinquished by: Received by4A I t2 P : <br /> Date: �7'` Ft Time: 8 '4J Date: f-fid �1� Time: 9yr Date: Time: Date: Time: <br /> Iv '7-' PLEASE READ REVERSE SIDE FOR TERMS AND CONDITIONS <br />
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