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ARCHIVED REPORTS_XR0008730
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_XR0008730
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Entry Properties
Last modified
7/7/2020 9:54:10 AM
Creation date
7/7/2020 9:40:58 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008730
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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LSauers
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EHD - Public
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.■... et�� gra w■� �� � �� � � � � � � l• E• S � <br /> ( Advanced CHAIN OFCUSTODY4tECORD <br /> GeoEnvironmental, Inc. Date 2# b3 Page ot-AL- <br /> 837 Shaw Road Stockton, California- 95215-(209)467-1006- Fax {209) 467-1118 <br /> Client � Protect na er Tests Required <br /> P ne Number <br /> ),q�72 /,0 0� <br /> amplers Signature) Invoice <br /> I <br /> Protect Name // AGE <br /> rel Client ❑ <br /> Sample Location Sam Type No of ` <br /> Number Description <br /> Date Time Water Air Solid Conts Notes <br /> Comp Grab <br /> 7 <br /> I cy O <br /> -7 1 U 00 .� n <br /> `T -)(in <br /> MW T5A V141,631 iz% i <br /> MO 911 z 1 1153 <br /> ;Re3uI y�ature) Received by (Signature) DatalTime <br /> �c.-v3 / !b 30 <br /> ishe y (Signature) Received by (Signature) Date/Time <br /> Relinquished by (Signature) Received by Mobile Laboratory for field analysis (Signature) DatelTime <br /> Dispatched by (Signature) DatetTime Received for Laboratory by DatelTime <br /> Method of Shipment f. Tato Ma -Q j /0 (YJ <br /> W a vans �,t <br /> L .4v c <br /> Special Instructtons I hereby authorize the performance of the above indicated work <br />
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