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SITE HISTORY FILE 1
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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2103
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3500 - Local Oversight Program
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PR0544591
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SITE HISTORY FILE 1
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Last modified
6/21/2019 2:19:54 PM
Creation date
6/21/2019 11:31:28 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE HISTORY
FileName_PostFix
FILE 1
RECORD_ID
PR0544591
PE
3526
FACILITY_ID
FA0005220
FACILITY_NAME
CHEVRON #9-4054
STREET_NUMBER
2103
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12308029
CURRENT_STATUS
02
SITE_LOCATION
2103 COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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'� NN 7 CCS <br /> .G Gfi <br /> G < OWNE� AH✓ OWNER PHONE # <br /> E T= <br /> E < CONTRACTOR <br /> elz / Ft�C✓�C CON. PHONE# <br /> R < SJLHD PERMIT { EPA # FIRE PERMIT # (J <br /> A <br /> L <br /> INSPE T DATE/Q 6 TANK # 39 _ �- <br /> R RINSED, Y/ ) METHOD ze RINSE AMOUNT <br /> 3 RINSATE DISPOSAL SITE <br /> IZ3 E MANIFEST # -OR- OTHER <br /> b V VAPORS PURGED (Y/N) METHODAMOUNT USED /� <br /> A C <br /> P L.E.L. READING AT REMOVAL (MUST 4E < 20%) <br /> 0 <br /> T R COMMENTS <br /> A <br /> J N TANK MATERIAL ( <br /> K C STE , FIBERGLASS, OTHER) TANK SIZE <br /> PN TANK CONDITION (GOOD, POOR, HOLES) Sin Q4uti <br /> I S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> v I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> T <br /> �a F A — � <br /> I N N <br /> E K <br /> V L <br /> D EXCAVATION SIZE: X X f--� YDS OF SOIL : <br /> S- <br /> \ I A DEPTH SOIL TYPE OBSERVATION SAMPLE # <br /> N M P <br /> �Rl S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION XX YDS OF SOIL <br /> I — <br /> 0 H DEPTH TO G.W. : FT SAMPLING METHOD <br /> N 2 <br /> 0 # OF HOURS SINCE DEWATERING: <br /> aOTHER SAMPLE: <br /> LABORATORY: G7� SAMPLERS NAME 0. <br /> CLOSURE IN PLACE MIXTURE: VOLUME: <br /> DRAW SITE t4iP ON REVERSE P T <br /> U <br />
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