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ARCHIVED REPORTS_XR0011859
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_XR0011859
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Entry Properties
Last modified
12/6/2019 5:25:51 PM
Creation date
12/6/2019 4:43:47 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011859
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
Tags
EHD - Public
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2795 2nd Street,Suite 300 ` <br /> Davis,CA 95616 <br /> Lab: 530297.4800 c <br /> ANALYTICAL c.cc Fax:,530,297.4808 Lab No. j <br /> Project Contact(Hardcopy or PDF Page of <br /> . California EDF Report? EJ Yes 0 No <br /> I C 14 #A) OTo� Chain-of-Custody Record and Analysis Request <br /> Company/Address: 11!��but„t mwxWwto co i%disnc-i <br /> P[ Sampling Company Log Code: An (� <br /> L N Ui 07 ysis Request <br /> PhD a No. FAX o Global ID: m X <br /> q/�' ICY 9/� �Sl-a - - _ �, m m i <br /> o _ <br /> Ca C4 <br /> Pro ect Number P.Q. No: EDF Dell rable T mail Address}: oNN � m a1 <br /> OL d m o u'SuS �. _. x <br /> _ :: <br /> Project Name: Samp r gn $ G m m a <br /> Moore peitzle �' � W a C -- W Q <br /> Project Address: � a a N m 'U M o N <br /> Sampling Conta r Preservative Matrix <br /> C a m c7 m o t t m .��. U. v <br /> 4 m <br /> W 111 W 0 tv w w iID <br /> m m N <br /> 17 W Z H <br /> Sample Designation Date Time _ _ 0 z° 3 N a. a a o o@ <br /> m m u: a. ir, ti w > r <br /> 0 - 9 .rd511• o <br /> 11-fo3 is a <br /> i <br /> i <br /> Relin wish Date Time Received by: Remarks: <br /> Reiinquis by; Date Time Received by: <br /> ------------------- <br /> Relinqu h by: Date Time Received by Laboratory; 1Ci !I to <br /> I Distribution: White-Lab.Yellow-File,Pink-Originator <br /> Formslcoc 121001.fh9 <br /> i' <br />
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