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ARCHIVED REPORTS_XR0012692
Environmental Health - Public
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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_XR0012692
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Entry Properties
Last modified
12/6/2019 5:54:55 PM
Creation date
12/6/2019 2:59:49 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012692
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
Tags
EHD - Public
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R <br /> . y <br /> MUC074AL <br /> Sam}p(e ldentiftation�eld Chain of Custody Record <br /> CONS(J'.. MTS,INC. <br /> Project - F . <br /> Shipped <br /> W.O. <br /> Shipped# piled to: <br /> fII1.H r <br /> � Attention <br /> on <br /> t: <br /> Bazardoes m <br /> at9rials suspected?(ye <br /> s no) <br /> POK lo:atier, Fiatd ID art Date Type containers <br /> RoqWrod <br /> ------------ <br /> i <br /> 1I <br /> O ,,� , <br /> I <br /> Sam .. <br /> s n . <br /> ' a re <br /> pier(}(signature) <br /> Field ID RO t>r{signature) fiacsived Iay (a nature) Data <br /> /Ttma t:aanmaris, v <br /> I <br /> Sealed for shipment by:(signature) <br /> DatryTime Shipment method: <br /> Received for Lab by:(signature) Date/Time <br /> Comments <br /> t <br /> R fl ltory�pleese.r�e—tur`n�.o_r._l7lnal�, afterer{tiflrins 1q> aa�ttplea. - i <br /> - <br /> g' <br /> rtiCeipt of <br /> i <br />
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