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ARCHIVED REPORTS_XR0011863
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_XR0011863
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Entry Properties
Last modified
12/6/2019 5:37:01 PM
Creation date
12/6/2019 4:47:57 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0011863
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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`ALIFO 'T LABORATORY SERVICES CHAIN CUSTODY 2d CLS ID. NO. <br /> Report To: Client Job Number ANALYSIS REQUESTED FIELD CONDITIONS: <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: 1124 Pyrites Way <br /> City,state, g d m k X y <br /> and zip: Gold River, CA 95670 X CLS (916) 638-7301 -v 8 o e g <br /> Project <br /> Name: Moore Petroleum 3249 Fitzgerald Road <br /> n m 0 O 0 0 0 <br /> Project Rancho Cordova, COMPOSITE: <br /> Manager. SR CA 95742 n 1 5 1 s 2 a ; <br /> Contact Contact C 5 5 e 0 t <br /> Phone: ( 916 )851-0174 Fax: 916 851-0177 ❑ OTHER M n of <br /> Sampled <br /> e 5 <br /> By: <br /> Job 8 <br /> rd <br /> Description: 3QMR water 0 8 �+ <br /> Site 1 2 TURNAROUND SPECIAL ' <br /> Location: 5491 F street, Banta 5 6 TIME IN DAYS INSTRUCTIONS <br /> SAMPLE CONTAINER *DL for MTBE <br /> DATE TIME TYPE 0 1 2 5 1Q ' <br /> Il]ENTIFICATIOn� MATRIX No. 1.0 ppb for F <br /> p?- w 0- v 1 L x Domestic <br /> (�p vew`al well <br /> 4 <br /> INVOICE TO: <br /> PO# f <br /> QUOTE# <br /> SUSPECTED CONSTIT ENTS SAMPLE RETENTION TIME PRESE A IVES (1)HCL (3)=COLD <br /> (2 3 (4) <br /> L QUISHED IGN) PRINT NAME/ MPANY 9ATFITIME RE EIVED BY(SIGN) R[ NAME COMPANY a' <br /> DATCONDITIONSRECEVDD TLABBY: 0Z3oZao3 <br /> COMMENTS: <br /> SHIPPED BY: ❑ FED EX 11 UPS ❑ OTI"IER AIR BILL# <br />
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