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ARCHIVED REPORTS_XR0011862
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_XR0011862
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Entry Properties
Last modified
12/6/2019 5:37:33 PM
Creation date
12/6/2019 4:47:21 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011862
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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EHD - Public
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Na� •�a-r�-- <br /> ALIFORNIA 4BQRATORY ERVICES CHAIN OF CUSTODY CLS ID. NO. <br /> Report To: Client Job Number ANALYSIS REQUESTED FIELD CONDITIONS: <br /> Name: Apex Envirotech, Inc. No: ERA02.004 T T T T B 5 <br /> P P P P T o <br /> Street <br /> Address: 11244 Pyrites Way Destination Laboratory H H H H E x <br /> City,State, g d m k X y . <br /> and Zip: Gold River, CA 95670 X CLS (916) 638-7301 -0 .8 o e 9 <br /> Project m 8 0 8 r 8 e <br /> Name: Moore Petroleum 3249 Fitzgerald Road cn <br /> Project Rancho Cordova, m 0 1 0 o 0 n COMPOSITE: <br /> Manager: SR CA 95742 y 1 5 1 s 2 a <br /> Contact Contact C 5 5 e 0 t <br /> Phone: 916,)8,f1-W74 Fax: (916)851-0177 ❑ OTHER coria n e <br /> Sampled <br /> B : e S <br /> Job <br /> Description: 4th QMR water 0 g <br /> Site 1 2 TURNAROUND SPECIAL <br /> Location: 5491 F street, Banta 5 6 TIME IN DAYS INSTRUCTIONS <br /> DATE TIME SAMPLE CONTAINER 0 *DL for MTBE <br /> 1 2 5 10 <br /> IDENTIFICATION MATRIX NO, TYPE 1.0 ppb for <br /> I q o 3- � MI`�= Q v x Domestic <br /> well <br /> 0 l0 3 S <br /> V C 4—qAlternate ID: <br /> V\f 2 <br /> EVJ <br /> SUSPECTED CONSTITUENTS SAMPLE RETENTION TIME PRESERVAT ES (l)HC (3)=COLD <br /> - <br /> RELINQUISHED BY(SIGN) PfJNT NAME! O PANY A E/TIME RECE ED Y(SIGN) P T AME/C PANY <br /> KA 1V6wa,\/AqPx b too' yf <br /> G <br /> REAIVED LAB BY: DATEITIME: CONDITIONS <br /> �D �[✓L'(D C7 COMMENTS: <br /> SHIPPEllL ❑ FED EX El UPS El ;j _ AIR BILL# � <br />
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