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ARCHIVED REPORTS_XR0011881
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_XR0011881
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Entry Properties
Last modified
12/6/2019 5:52:02 PM
Creation date
12/6/2019 4:53:15 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011881
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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CALIFORNIA LABORATORY SERVICES C AIN OF CUSTODY CLS LL). NO.cC-�-- 01eZ- 2 of z <br /> Report,ro: clictlt Iola Number ANALYSIS REQUESTED STFD GEpTkAC}:Lit <br /> Name and Address ER�.0�2.004-QLM T T T T $ I 5 l <br /> P P P F T a >,DFREPORT x YES ❑ NO <br /> Ape1Jlivirotecla, LTi C. ltstinatian Ls6olatary H H H E x B <br /> {iLOBALID,113607704153 <br /> 11244 Pyrites Wy., Gold River,CA 95670 g d k In K y <br /> Proiecilfanagcr <br /> PULS (916) 638-7301rn 8 S e a & <br /> 12ich J,�hn.snn 3249 F'pt�p-gerald Road !1 <br /> Project Nam 12attcho Cordova,CA I 1 0 0 0 n 1 <br /> Moore Petroleum 95742 5 S j t FIELD CCf�13[TEI�NS: <br /> Sampled Lty 1Y1Y�V.G 1111Ur;tl:ila�17.!`Otlt � c7 <br /> 10l ikrcription aT1rEIi D 8 D CGhlPosl7E: <br /> I"t1lrwater e S C1 <br /> $ $ A analyze for MTRF only <br /> Site Location0 2 <br /> �_................ -- <br /> 591 Fstrc'ft,13aE,rg 1 6 Tt3E;Gi1AR0C31n SPMAL <br /> 50 Tli4'FE LN DAYS INSTRUCTIa-S <br /> DATE TIME SAMPLE FIELD CONTAINER T DL for axyg.= <br /> IDENTIFICATION ID- MATRIX —NoTYPE 5 10 0,50 <br /> RW-2 RNV-2 .eater 311 VIA 1 X x x X X K <br /> Rhodes Rhodes water 311 VIA 1 X X <br /> LEE <br /> PCP <br /> QUOTEA <br /> SUSPECTED CONSTITUENTS Sr\h PLE RI TENTION TIMI F'R£SEECVA'E'IYE$ (I)IdCI {3j=CALL) <br /> 12 IINO, <br /> RELINQUIS r)fjy(SiS,naturc) PRINT NANIFJCOWPANY A "TI-ME Iillr L#Y i�uE ) PRINTNAj\fEj(-() 4 <br /> f <br /> I Cuv D. 'I-L 8 fIATEJi[1tE: O'�Utl"l4N5rCOii�1E IS: ` <br /> — SHIPPED BY, ❑ FED EN, � 0 (JPS 13 OTrIER AIR 131LL# <br />
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