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ARCHIVED REPORTS_XR0011870
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_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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2795 2nd Street, Suite 300 <br /> Davis,CA 95616 <br /> ANALYTICAL LLc Lab: 530.257.4800 <br /> Fax: 530.297.4808 ~� <br /> Project Contact(Hardcopy or PDI=To); Lab <br /> CaFifornia EDF Report? ❑ Yes a Page of <br /> ICN Chain-of-Custody Record and Analysis Company/Address: �� �/ s Request <br /> PExE►� V�2o ' <br /> 'rC'�i L Sampling Company Log Code; <br /> Phone No.: tLrr LT Analysis Request FAX NO� Global!D: � <br /> sl- 617-V sl- L 7 - - 1. m X <br /> Project Number d o n <br /> 6 N ~ <br /> P.O..No: EDF Deliv ble {Small Address}: W "' <br /> � 02. pp ,ALU <br /> Pro'ect Dame: m '� '� <br /> N � LU <br /> ? - Sampler i at $ � �,, mm <br /> Project Address: <br /> m o <br /> w w " <br /> c� <br /> CA <br /> Sampling a Con er Preservative Matrix <br /> W a] `� S F- m m m M m J <br /> d, x p o m m m c0 V e L <br /> u► w m " m m ry z <br /> Sam le Designation ' ° Z F- J rn `r L <br /> Date Time v v, ' m C N <br /> � z p ¢ 'u5 <br /> _ = U z w a a a A A O a m a <br /> J <br /> 3-9-0 �'C 4 - m m F H ,n in ti � w <br /> 9 IV <br /> C.) <br /> R inqui h Y. Date Time Received by: <br /> SIS Remarks: <br /> Relinqui e <br /> Date Time Recpivwi <br /> Relinqu h y:. Date Time <br /> Received by Laboratory: <br /> 3 <br /> 'cog L"'SIS Bili to; <br /> DistrrbcRion• White-Lab, Ainh-Originator - r'v � `S�L <br /> Fomes/coc 1210o1.th9 <br />
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