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ARCHIVED REPORTS_XR0008728
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_XR0008728
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Entry Properties
Last modified
7/7/2020 9:53:30 AM
Creation date
7/7/2020 9:39:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008728
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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Advanced CHAIN OF CUSTODY RECORD <br /> GeoEnvironmental, Inc. Date -�7-02- Page Z- of 1 <br /> 837 Shaw Road - Stockton, California-95215- (209)467-1006- Fax (249) 467-1118 <br /> ClientProject Manager <br /> �tJ �, C3 9,j\ L, Tests Required <br /> Phone Number <br /> 2-0`l 4ko7-/va(a <br /> Sample (Signature) ��► �� Invoice <br /> Project Name �,► a+. r F �e C� b� AGE �} <br /> f V I'� QG �.��� o� aL ` Q Client ❑ <br /> � U <br /> Sample LocationSa ple Type No of <br /> Number Description Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> IWO.;'AToo L 1-17-vz V731 <br /> 1L ����l7oZ 9--17-0?- V707 <br /> lWta-/05?17a4 <br /> �41(0el0fm2- (NO MW-J San. 1e <br /> 16v IQ/o91F0-L 9-M-;z <br /> 14V7a/a91S0z I 1-ye-OZI <br /> elinqu. hed b ( ignature eceive y (Signature-F Q le/T+me <br /> c cam- 6 <br /> Relinquished by (Signaturbil Received by (Signature) DalelTime <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) Dateffime <br /> I <br /> Dispatched by (Signature) :E Date/Time Received for Laboratory by Datp/Time <br /> i 4lzioL <br /> Method of Shipment Laboratory Name <br /> C�/ Q veT n ca tech <br /> Spaoml,lastrucuons I hereby authorize the performance of the above indicated work <br /> i <br />
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