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HAZARDOUS WASTE GENERATOR <br />FILE COVER SHEET <br />FACILITY ID#: FA0006439 P/E: 2351 DATE: 12/07/2007 <br />PROGRAM RECORD #: PR0231070 P/E: .7y1�o DATE: <br />JL5140Lt 57 P0 P/E: DATE: <br />ADDRESS: 2575 COUNTRY CLUB BLVD CITY: STOCKTON <br />FACILITY NAME (DBA): COUNTRY CLUB 76 GAS STATION* <br />FACILITY PHONE: (209) 948-0574 <br />FACILITY FAX: <br />FACILITY CONTACT: CALIFORNIA FUEL SUPPLY INC PHONE: (415) 516-7676 <br />OWNER NAME: CALIFORNIA FUEL SUPPLY INC CITY: WALNUT CREEK <br />OWNER ADDRESS: 587 YGNACIO VALLEY RD <br />Water Service: <br />Sewer Service: <br />Large PWS <br />Public Server <br />Small PWS <br />Q OnSite WWTX <br />Stormwater: Street Drains ❑ Street Ditches <br />EPA ID#: C/42-OOo��B� j0 <br />Ht-' 2-6,- <br />EH 00 18 rev 05/2007 <br />rpt # : HWCS <br />PHONE: (415) 516-7676 <br />Domestic Well <br />OnSite Septic System <br />Q Onsite Ponds ❑ Other <br />New Owner. Create a New Cover Sheet/ Change Label of File <br />