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WATERLOO
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2900 - Site Mitigation Program
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PR0537118
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COMPLIANCE INFO
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Entry Properties
Last modified
5/27/2021 3:03:45 PM
Creation date
5/27/2021 2:37:55 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0537118
PE
2957
FACILITY_ID
FA0021303
FACILITY_NAME
WATERLOO FOOD & FUEL
STREET_NUMBER
3032
STREET_NAME
WATERLOO
STREET_TYPE
RD
City
STOCKTON
Zip
95205
CURRENT_STATUS
01
SITE_LOCATION
3032 WATERLOO RD
QC Status
Approved
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SJGOV\dsedra
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EHD - Public
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‘ Advanced GeoEnvironmental, Inc. vvww.advgeoenv.com CHAIN OF CUSTODY RECORD <br />837 Shaw Road, Stockton, California 95215 • Phone (209) 467-1006 • Fax (209) 467-1118 12 /co Date: I Z-17 - / 2" Page - ( of 1 ' <br />381 Thor Place, Brea, California 92821 • Phone (714) 529-0200 • Fax (714) 529-0203 <br />2318 Fourth Street, Santa Rosa, California 95404 • Phone (707) 570-1418 • Fax (707) 570-1461 Analysis Required <br />395 Del Monte Center, #1 I 1, Monterey, California 93940 • Phone (800) 511-9300 • Fax (831) 394-5979 <br />Nf \ CP' <br />LC:ski 7-7-- x <br />Project Name <br />i • -el/ <br />,- <br />et) "E-a-A 4 ......?.1 <br />Project Manager V -‘i i 1 ',....1.4i n <br />Client . L„--10-4 I/ ty <br />Sampler (initials & signat j <br />.0) . <br />ci:"; <br />1 <br />c...< —5: ., <br />%e. <br />Invoice to: AGE 0 Client <br />i Lab Project No.: <br />'-= <br />Sample 1D/Location/Description Date Time Matrix Number Notes <br />• r-- . tp .cS').. <br />ittkvi - 1 At I-) vt 17,1117- V2-0-9 vi 3 '4CX:•›C <br />rtuo - 2 /a. 0 a 2- <br />.ovkw- 3/(2A-1 i E, 1 \ LIAO <br />1 <br />tk 7j—i <br />'mAik) - S RAW 12. <br />VW - bi,/i7;t1 It 1 b ‘''' I 1 <br />IAA) —74 /11,11 17, <br />v\AV -iNitz:t7i/ 1 o5 9 <br />? \ v \A.W- oi 1/1112 ..7-)Y21 1 <br />vau -12-/12A1 it, if V Vzi35 -Cf Yv7 V v,/ v. -4 <br />Relinquished <br />Courier: <br />,..,,,......" Date: Time: Labor <br />C <br />atory: <br />( <br />f <br />6st --1---ea-' <br />rnIA_/. 6, 6-- , <br />Received by: Date: Time: <br />Relinquished by: Date: Time: Received by: Date: Time: <br />Relinquished by: Date: Time: Received by: Date: , . <br />I 21 11 5" 2__ <br />Time: <br />ro; 0-- <br />Requested Tum Around Time (circle): 24 hours 48 hours 72 hour 4 days (standardlpther: Matrix Codes: A = Air W = Water S = Solid <br />Special Instructions to lab: I hereby authorize the performance of the above indicated work. A <br />/ <br />Geotracker EDF to geotracker@advgeoenv.com LI Global ID:
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