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ARCHIVED REPORTS_XR0011870
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_XR0011870
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Entry Properties
Last modified
12/6/2019 5:50:11 PM
Creation date
12/6/2019 4:50:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011870
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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t - <br /> 27952nd Street, Suite d <br /> Davi 30 <br /> Davis,,CA 95616 <br /> ANALYTICALLLC Lab. 530.297.4800 f / --7 <br /> Fax, 530.297.4$08 Lab No. e?tj� <br /> Project Contact(Hardco y or PD To): . Page of <br /> �SD� California EDF Kapott? ❑ Yes ° <br /> Chain-of-Custody Record and Analysis Request <br /> ompany/Address: ,ry,�„ , toy <br /> —CJ f i7 Sampling Company Log Code: <br /> IlC� L• Analysis Request <br /> Phone No.: FA?(No.: Global ID: <br /> v0/7 <br /> m <br /> Pro, ct N� r. P.O.No: $ � m �' <br /> Ll EbF Deliver le To Em ddress�: _ _ to a <br /> m <br /> m <br /> 4! W N V <br /> c <br /> Proj Name: N � �, CO C <br /> � O <br /> �Moore, � rrw Sampler 5 at L .'0 1m�� a <br /> Project Address: x = CO y , i C _ <br /> d ��1 �� Sampling Contal a Preservative Matrix _ � _ o N r <br /> I'v m a� of <br /> m U' o F m m m � m L <br /> TuL", <br /> �-�L a T m ° m O <br /> a i1c ckSam ie Desi nation o w z x Date Time i = U z o w a a o 0 0 o m a _� m <br /> U) <br /> m m k0 a ° ° <br /> � W ' J <br /> -0108 -l1UF F -a L <br /> 2 <br /> Rei ished b Date T'm,e Received by: <br /> Remarks: <br /> Relinquished Dale Time Received by: <br /> Relinquished b : Datelime Received by Laboratory: <br /> p0o+� 0°lS lC21 R AAA LIrrtCi to: <br /> Distributi0n: White-Lab, Pink-Ofiginaror <br /> Formsicoc 121001.th9 <br />
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