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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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SJGOV\wng
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EHD - Public
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2795 2nd Street, Suite 300 <br /> Davis,CA 95616 <br /> ANALYTICAL ctc Fab: 530.2 <br /> F'ax: 530.237.4807.480 0 8 Lab No. �C7 / <br /> Praject Contact(Hardcopy or PDF To): Page-of <br /> Cafifornii EDF.Repott? ❑ Yes <br /> RlC H�S0/U Chain-of-Custody Record and Analysis Request <br /> Company/Address: PAOM MUlad <br /> Sampling Company Log Code: <br /> Phone No..- Analysis Request <br /> F NF <br /> o.: Global ID: <br /> ca <br /> m x <br /> M to <br /> C14 <br /> Project Number. P.O.No: <br /> EDF Dellve o(Erna dress): m m <br /> W CY 7E <br /> Project Name: Sam e� igna �, m a D <br /> z Per I�uWt m o t <br /> Project Address: b 0 0 o a w <br /> Sampling _ a � o `s <br /> P 9 Cpn Preservative Matrix _ o a a _ $ N ro <br /> 02 <br /> �jlfly r�r 1 � a m C7 rR o F m m n a � Y � rQ'i � J <br /> O _m m c m m0 LL <br /> `� v `O <br /> CM <br /> ry aS D m 0 <br /> W <br /> TMONOW <br /> Z t-- -J Q id C7 m @ I-- -J m .^-.Sate fe Desi nation Date Time a sir = i rn a x a a R a R <br /> O <br /> 6 '//� Zia-�'l �j/b 0 <br /> OZ <br /> Relinqui h b Date Time Received by: <br /> Remarks: <br /> Relinquished Date Time Received by: <br /> Relinquished Date Time Received by Laboratory:�� <br /> 021L0 Bill to: <br /> `� ibq$ /� �Av c7W_tL_ <br /> Distribution: lft4 ab, Finh-orfginator <br /> Formslcoc 121001.th8 <br />
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