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ARCHIVED REPORTS_XR0011825
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_XR0011825
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Last modified
12/6/2019 5:15:23 PM
Creation date
12/6/2019 4:34:04 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011825
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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CLS - !( yS CHAIN OF CUSTODY <br /> CLS ID No.; ,S-t <br /> NA ND ADORES LOG NO.10 7 6 4 <br /> REPORT TO: CLIENTJOB NUMBER ANALYSIS REQUESTED FIELD CONDITIONS: <br /> /7 011. 00 q <br /> r K Q k <br /> L DESTINATION LABORATORY �G Q <br /> fj X CLS {916) 638-7301 b @j <br /> r n <br /> T MAMA R PH NE# 3249 FITZGERALD RD. m y► r - X <br /> . 0260 RANCHO CORDOVA,CA. (/� 1 .r °1 q <br /> PROJ C NAME COMPOSITE; <br /> /rum' 9$742 m t J <br /> 0 61 m r` <br /> SAMPLED BY �S ❑ OTHER C <br /> JOB D <br /> IT! <br /> SITE LOCATION NL�\ �� y Q,. TURN AROUND TIME SPECIAL INSTRUCTIONS <br /> DATE TIME SAMPLE IDENTIFICATION CONTAINER <br /> MATRIX NO. TYPE <br /> ��of Gl-00 <br /> lo: O <br /> lz:3o <br /> • s <br /> y�3 4 a <br /> :0 M ,L,> <br /> '-3 ' + INVOICE TO: <br /> 140- 11 <br /> PO.# <br /> QUOTE# <br /> SUSPECTED CONSTITUENTS <br /> SAMPLE RETENTION TIM PAESERVATIVES: (1)HCL R (31_ <br /> (2}HNO3 -COLD ELINQUISHED BY SIGN) PRINT NAME 1 COMPANY DATE/T E (4) <br /> IVE (SIGN) T E/CO PAN <br /> (0 9 G 1 <br /> �-2C T BBY.. DATE/TIME: <br /> CONDITIONS/COMMENTS: <br /> S PPED BY: FED X UPS ❑ OTHER <br /> AIR BILL# <br />
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