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ARCHIVED REPORTS XR0003472
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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2575
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2900 - Site Mitigation Program
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PR0541989
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ARCHIVED REPORTS XR0003472
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Entry Properties
Last modified
6/21/2019 9:16:46 PM
Creation date
6/21/2019 3:34:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003472
RECORD_ID
PR0541989
PE
2950
FACILITY_ID
FA0024100
FACILITY_NAME
COUNTRY CLUB VALERO
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12302012
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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Sj <br /> l b <br /> i <br /> BILL OF LADING <br /> 3909 Park Road, Suite D <br /> Benicia, CA 94510 <br /> lVVIRONMENTAL SERVICES <br /> GROUP (877) 748-3040 <br /> Western Region <br /> DELIVERY DATE JOB A <br /> SHIPPER/CUSTOMER POINT OF CONTACT <br /> OyTk -I KART Ell% <br /> =MDDRESS PHONE# <br /> ATY STATEy ZIP <br /> 'ARRI(ER/TRANSPORTER <br /> 3Y Y 1� p <br /> FIN <br /> (y PHONE# !] <br /> L1IN IR�'r �f+.�.! 3!�!�.i !44 7 <br /> '.ONSIGNEE/FACILITY POINT OF CONTACT <br /> kDDRESS PHONE# <br /> :rlY STATE ZIP <br /> i gx t r'ti , CA 95'3.a€r <br /> 3 <br /> D <br /> 40cral Handling InstrucLon and Additional Information <br /> s3 WTUIX-'1$ WASTR SOHiI. !SGIL AMC ra-VIAMw iNkm fRom 4;,(mpm, M.OGS Y 193KRU <br /> �KM- '-W, 649 M' t=".§j 50 17?7 FORWARD AC(!iPTkN g 11481 <br /> 'lacards Provided YES NO Emergency Phone#(877) 748-3040 <br /> SHIPPER S CERTIFICATION i hereby declared that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed <br /> narked and labeled,and are in all respells i i proper condition for transport by highway vessel and rad according to applicable international and national government regulations; <br /> ,SHIPPED)PRINT OR TYPE NAME,' i s , r __ /lSIGNATURE r MONTH DAY YEAR <br /> •4/ X <br /> ,CARRIER/TRANSPORTER)PRINT OR TYPE NAME SIGNATURE = <br /> r - M14Nni DAY <br /> ,CONSIGNEE/FAClUTY)PRINT OR TYPE NAME F" ,SIGNATIPE MONTH IPAY_ Yem <br /> L <br /> -orm#PSC-201-RV 6/04 <br /> SHIPPER <br />
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