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ARCHIVED REPORTS_XR0008734
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_XR0008734
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Entry Properties
Last modified
7/7/2020 9:56:08 AM
Creation date
7/7/2020 9:42:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0008734
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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• • • <br /> Advanced CHAIN OF CUSTODY RECORD W <br /> CeoEnvironmental., Inc, C oats Pass of, 00 <br /> N <br /> 937 Shaw Road-Stockton, California- 95215 -(2D9)467-1008-Fax 1209)487-111$ m <br /> m <br /> Lae <br /> N <br /> Tests Required <br /> Phone Number <br /> M <br /> N <br /> Samplers. (Signature) Invoice <br /> Pro)ect Name ._ AGE)Z <br /> OL -clent <br /> Sample Location Sample Type 00 <br /> Number Descrolon Date Tirne Water Air Solid No of 5 �1 es <br /> Camp Grab -- - — -- -� - <br /> '� ftp j - `� 3 82063 <br /> D <br /> m <br /> m <br /> o <br /> I <br /> i^7 b <br /> S[ <br /> e urgws ed y j3kqIrAlI acarus ignaiure <br /> DeAoll•�me <br /> flebnqurshed y el liace3Yed�y (Sgnature) (J'�`+f(t/r �'`+�'�' � �` rr~ <br /> Dats1T[r»e <br /> Relinquished by (Signature) lieveived by Mobile laboratory fat held vWysrs (Qgnatura) Dat <br /> efTrme <br /> Dispatched by (Signature) DawMme Reixived for Laboraft 0 rme <br /> Method o1 shipment- <br /> 0 shipment— Laboratory Name U <br /> 1 ; D <br /> �C m <br /> special inalruatfons J hereby authorize theMperformance of the above Indicated work <br /> CD <br /> �1A Lo <br />
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