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ARCHIVED REPORTS_XR0011862
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_XR0011862
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Last modified
12/6/2019 5:37:33 PM
Creation date
12/6/2019 4:47:21 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011862
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 - Labs CHAIN OF CUSTODY CLS ID No.; (A-?° 1 LOG No. 22630 <br /> REPORT TO: CLIENT JOB NUMBER ANALYSIS REQUESTED FIELD CONDITIONS: <br /> NAME AND ADDRESS rl f�q�i K6 tW-ft—J' O <br /> /�n �GDESTINATIO(IV'LABq�fRATORY <br /> � <br /> 1 W CLS (916) 638-7301 M <br /> -117A1 <br /> PROJECT MAN GER p NE 3249 FITZGERALD RD. MQ COMPOSITE: <br /> RANCHO CORDOVA,CA. (1) Q h <br /> PROJECT NAME �}�f l 95742 M l.Vl �J <br /> SAMPLED BY I. Pali ElOTHER n <br /> JOB DESCRIPTION ((�� <br /> N" `� TURN AROUND TIME SPECIAL INSTRUCTIONS <br /> SITE LOCATION �^ `, ^ <br /> DATE TIME SAMPLE CONTAINER ' o o o o <br /> IDENTIFICATION MATRIX NO. TYPE <br /> fi Bc <br /> j <br /> dgss��� <br /> INVOICE TO: <br /> P.0.# <br /> QUOTE# <br /> SUSPECT CONSTI ENTS SAMPLE RETENTION TIME PRESERVATIVES: (I)HCL (3)=COLD <br /> (2)HNO, (4) <br /> R DISHED BY(SIGN) PRINT <br /> `NAM 1 COMPANY DATE 1 TIME RE EIVED (SIG ) PRINT NAME 1 COMPANY <br /> L A k <br /> REC'D AT LAB BY: DATE I TIME: CONDITIONS/COMMENTS: <br /> 3 -dZ DO0 <br /> SHIPPED ' ❑ FED X ❑ UPS ❑ OT AIR BILL# <br />
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