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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. www.advgeoenv.com CHAIN F CUSTODY RECORD <br />E837 Shaw Road, Stockton, California 95215 • Phone (209) 467-1006 • Fax (209) 467-1118 Date: i Page ( of( <br />381 Thor Place, Brea, California 92821 • Phone (714) 529-0200 • Fax (714) 529-0203 Ol <br />2318 Fourth Street, Santa Rosa, California 95404 • Phone (707) 570-1418 • Fax (707) 570-1461 <br />2-3 —) <br />Analysis Required <br />395 Del Monte Center, #11I, Monterey, California 93940 • Phone (800) 511-9300 • Fax (831) 394-5979 <br />---Z. <br />Project Name i, I _p / ' <br />A Jarer li,o iLivk 1-- Ft:1P I <br />Project Manager 0 i / <br /> <br />tot i'i i--/ 7V-1-e_ <br /> <br />......2 ...... Client Sampler (inZics & signature) r <br />Invoice to: Iti- AGE 0 Client Lab Project No.: <br /> <br />Sample ID/Location/Description Date Time Matrix Number Notes <br />P..." <br />,- \-•U Lta; <br />FLO -I /i 06-4e-r- -1124,21A 1. .7 1 S/ lit) .7- )r )rrXd <br />E u)-2 /, ki6u-i-ei- 2- ',r)( -/V <br />E Li.) - Li / ii)-64-ef— 13 22_ 1- • <br />/ 3 y <br />I <br />z....., --\, A- AS/7),cd e r <br />-e--42 FIL,09A-cr totte./u. V 7XX <br />Relinquished by: Date: Time- Laboratory <br />Z 1g (i (2 5 (Tej <br />Courier: <br />niuliAe___ <br />Received by: Date: Time: <br />'Relinquished by: Date: Time: Received by: Date: Time: <br />Relinquished by: Date: Time: Received by: Date: <br />-1 <br />Time: <br />‘D: .:.."' • <br />Requested Turn Around Time (circle): 24 hours 48 hours 72 hours 5 days (standard) Other: 7 Matrix Codes: A = Air W = Water S = Solid <br />Special Instructions to lab: I hereby au .ze the ance of the above indicated work. <br />/ (I <br />/ 44, <br /> <br />Geotracker EDF to: El geotracker@advgeoenv.com 0 Global ID:
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