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ARCHIVED REPORTS_XR0008722
Environmental Health - Public
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EHD Program Facility Records by Street Name
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W
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WATERLOO
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3032
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2900 - Site Mitigation Program
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PR0537118
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ARCHIVED REPORTS_XR0008722
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Entry Properties
Last modified
7/7/2020 9:49:47 AM
Creation date
7/7/2020 9:35:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008722
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
Scanner
LSauers
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EHD - Public
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.� a..� ...�■ �at� alp tpl�� t� � � � � 1♦ i♦ � 1� � <br /> ( Advanced CHAIN OF CUSTOD RECORD <br /> GeoEnvironmentai, Inc. Date 24" Page / of <br /> 837 Shaw Road- Stockton, California-95215- (209)467-1006- Fax (209)467-1118 <br /> Client I/UI ..# ;a"0 T'—c Fu e Project Manager <br /> Tests Required <br /> Phone Number <br /> Samplers (Signature) Invoice <br /> Project Name � ,,f4 ��r � I A� � ��� y�� � AGE <br /> (/� Client ❑ <br /> Sample Location Sample Type �r. <br /> of <br /> Number Description Water Time Water Air Solid No <br /> Notes <br /> Com Grab <br /> -TTT' I' <br /> Relinquish y nature eee1ve y ignalure <br /> Date/Time <br /> Rehn unshed b S� nature ..- <br /> q y g ) Received by (Signature) Dale/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Date/Time <br /> Dispatched by (Signature) Dale/Time Received for Laboratory by DatelTene <br /> Method of Shipment <br />� Lazo tory Name <br /> i� �ti� r� <br /> Special instructions ` I hereby authorize the performance of the above Indicated work <br />
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