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ARCHIVED REPORTS XR0003475
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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 XR0003475
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Entry Properties
Last modified
6/21/2019 9:37:03 PM
Creation date
6/21/2019 3:37:27 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003475
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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• . <br /> SEQUOIA ANALYTICAL ® 885 Jarvis DrlVe * Morgan Hill, CA 95037 * (408)776-9600 * FAX (408) 782-6308 <br /> Q01). <br /> ❑ 1455 IN McDowell Blvd, Suite D * Petaluma, CA 94954 * (707)792-1865 * FAX (707)792-0342 <br /> CHAIN OF CUSTODY A8119 Striker Ave , Suite 8 + Sacramento, CA 95634* (916) 921-9600 * FAX (916)921-0100 <br /> Of 7 D 404 N Wiget Lane * Walnut Creek, CA 94596 + (925) 988-9600 + FAX (925) 988-9673 <br /> Company Name —' es S rock ray Protect <br /> Mailing Address ` 0 �v6-1,f,2Billing Address (if different) <br /> City �;ivr,&to State CA- Zip Code ,BLU;—OZY <br /> Telephone 2& -87o Fax# PO # a <br /> Report To ?w yv� �y E-mail Address Clh� CO/V„f jetlyiG3, QC Data vel II (standard) Ci Level til El Level IV <br /> Sampler 7] Date 1 Time Results Required Sequoia's Work Order# .cv O S f B <br /> Turnaround Ll 10-15Working Days t7 72 Hours MANDATORY ANALYSES REQUESTED Please pro <br /> method <br /> Time (Standard TAT) A8 Hours ❑ SDWA(Drinking Water) �z k% 8Z6 <br /> ❑ 7 Working Days ❑ 24 Hours jEi4–CWA(Waste Watery ryj04 $S p 4 <br /> ❑ 5 Working Days ❑ 2-8 Hours ❑ RCRA(Hazardous Waste) <br /> ❑ Other '�Qi <br /> � �� t` <br /> Client Date 1 Time ,A � � <br /> Sequoia's#of Container Se uoia's Q' <br /> o�.�r� , d Comments] <br /> Matrix <br /> Sam lel D Sampled Desc Cont 7 e Sample# ' �A r� Temp(If required) <br /> mL <br /> L�WJ 3 <br /> 0 o x <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> 7 <br /> I <br /> 8 <br /> L <br /> 9 <br /> 10 <br /> Relinquished by I Co o ,tri Received by 1 Co-------T— Date/Time/Tamp 0 -o R-o K t o <br /> Relinquished by/Co Received by I Co Date I Time/Temp <br /> Relinquished by I Co Received by I Co Date 1 Time I Temp <br /> Relinquished by 1 Ca Received by 1 Co Date/Time/Temp <br /> Page of— <br /> Were Samples Received I ndition7 "'- Yes <br /> Yes El No Samples an Ice? Yes ❑ No Method of Shipment <br /> White Sequoia <br /> Yellow Sequoia fink Client <br />
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