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ARCHIVED REPORTS_XR0011867
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_XR0011867
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Entry Properties
Last modified
12/6/2019 5:35:17 PM
Creation date
12/6/2019 4:49:02 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011867
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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2795 2nd Street Suite 300 .y <br /> rA(AFFDavis,CA 95616Lab:530.297.4800 Lab No. O 7� Page 1 of 1 <br /> NALYTICAL LI-C Fax:530.297.4808 _ <br /> Project Contact(Hardcopy or PDF To)- <br /> Rich <br /> op California EDF Report? ❑Yes Chain-of-Custody Record and Analysis Re test <br /> Mich Johnson p �No Y � q <br /> Company 1 Address: 0-m-ended but not mandatory to complete this section: <br /> Apex Envfrotech,Inc, sampling Company Log Code: Analysis Request Q <br /> 11244 Pyrites Wy„Gold River,CA 95670 I•-- <br /> Phone No.: Fax No.: Global ID: <br /> 916-851-0174 916-851-0177 70607700183 to O r <br /> Project Number: P.O.No.: EDF Deliverable Ta(E=exlrotw�r� <br /> easy: � °O L' <br /> Ef2A02.004 � <br /> r'ohnson m m W N24hr c <br /> Project Name: Sam ler o w ❑ 0 G <br /> Moore Petroleum Signature: w a a 48hr a <br /> Project Address: Sam 1117 1° o m o o a �, �, 0 O <br /> p g 0 er Preservative Matrix m <br /> 2 0 a n- o N 72hr <br /> N j <br /> 5451 F Sheet,Banta,CA Q m w y U_ 1l� Ii <br /> Sample � W a Ir d a o _ c r_ r � 0 _ N <br /> LU } il! r� z W O b w [7 aco <br /> go m is 'n N Qy <br /> Desi nation Date Time CD -J 0 a W 0 z v z ¢ O ¢ � � a a. rL � 0 0 0 � a � � 2wk <br /> 1 U) 7 m In F H I- �fi l� 4-i [� J W � °/j <br /> ~ V-GAC-EFF �1I-O�f X X X X <br /> 1 wk 6 1 <br /> + V-GAG1j-11--o4 x X X X <br /> • VEWMAN X 1 wk a1 <br /> X x X 1 wk 6 <br /> I TF <br /> Reflnquis Q Date Time Received byRemarks: <br /> woma L� <br /> u shed by. Date Time Received by. <br /> Relinquished by: Dat Time R e b La ora ory: Bill to: <br />
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