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ARCHIVED REPORTS_XR0011861
Environmental Health - Public
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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_XR0011861
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Entry Properties
Last modified
12/6/2019 5:31:23 PM
Creation date
12/6/2019 4:46:30 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011861
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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ALIFOA LABORATORY SERVICES S O <br /> CHAT CUSTODY CLS ID. NO. <br /> Report To: FIELD CONDITIONS: <br /> P Client Job Number ANALYSIS REQUESTED <br /> Name: Apex Envirotech, Inc. No: ERA02.004 T T T T B 5 <br /> P P P P T o <br /> Street Destination Laboratory H H H H E x <br /> Address: 11244 Pyrites Way <br /> City,State, g d m 'k X y <br /> and Zip: Gold River, CA 95670 x CLS (916) 638-7301 -n 8 o e <br /> g <br /> Project .� <br /> Name: Moore Petroleum 3249 Fitzgerald Road C" 8 0 8 r S e <br /> Project Rancho Cordova, M 0 1 0 o 0 n COMPOSITE: <br /> Manager: SR CA 95742 y 1 5 1 S 2 a <br /> Contact Contact C 5 5 e 0 t <br /> Phone: ( 9I6)8 1-P17Fax: ( 916 )851-0177 ❑ OTHER �M„ n e <br /> Sampled e S <br /> By: g <br /> Job <br /> Description: 1St QMR water 0 8 <br /> Site 1 2 TURNAROUND SPECIAL <br /> Location: 5491 F Street, Banta 5 6 TIME IN DAYS INSTRUCTICI'kS. <br /> DATE TIME; SAMPLE CONTAINERV 0 1 2 5 10 *DL for M�`13P- <br /> rP <br /> IDENTIFICATION MATRIX NO. -21 1.0 ppb for <br /> Iq <br /> 03 1)-op V`-(- Q x Domestic <br /> S`0 well <br /> \L1 d/ I \L Alternate ID: <br /> D— <br /> SUSPECTED CONSTITUENTS SAMPLE RETENTION TIME PRESERVATIVES (1)HCL (3)—COIF] <br /> (2)HNO, (4) <br /> RELNQUISHED BY(SIGN) P T NAME/ MPANY TE/TIME REf EIV/ED BY(SIGN) PRINT NAMEICO,MP Y <br /> QV <br /> f y <br /> RE IVED AT LAB BY: DATEITIME: CONDITIONS <br /> D Q T 1�� COMMENTS: <br /> SHIPPED BY: ❑ FED EX 0 UPS ❑ OTHER AIR RILL# <br />
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