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ARCHIVED REPORTS XR0003487
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 XR0003487
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Entry Properties
Last modified
6/21/2019 9:52:40 PM
Creation date
6/21/2019 3:44:53 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003487
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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Lab SHELL Chain Of Custody Record <br /> aadrese ails tgeorL(Lrneceseary} Equiva Project Manager to be invoiced: �6 <br /> f I�I�ICI�t'I+li�kt�IMEt�I+�Y� <br /> I <br /> Ory stale no acu Karen Petryna 9 8 91 91 61 1 8" 4 DATE <br /> I orEl�l3 �t�lEt� <br /> C> # C4t 1 PAGE / of Z <br /> Y L°o ADOPAW{ and C.a MO <br /> Blaine Tech Servlce9 aTSR <br /> wor�as 2575E Country Club Stockton T0607700697 <br /> 1680 Rogers Avenue,San Jose,CA 95112 CUIVEL.A"MMMMMw. + No <br /> FNOIECT OpNrACTIN.,Apppr a,POF R,rq,1 bK Joe WOW 745 $ <br /> Leon Gearhart 76733.2361 sottomae camtu#a�riv cam BT3f <br /> req rr+r.r EAa31 lt.'1' <br /> t18f <br /> 'TVAPHONE FAX EiMLL [ <br /> 408573 <br /> 73-0555 408. -777= I rh tr alrte h � <br /> corn Q� <br /> TUpNAROUNDTIME(BU51NEW DAY3g <br /> m DAYS ❑ S DAYS❑ n WM❑ 48 WX= ❑ 24 Houas❑ LESS THAN x4 HOURS I[ REQUESTED ANALYSIS <br /> ❑ u RWQC3 REPORT FORMAT ❑ UST AGENCY, <br /> GUMS MTBE CONFIRMATION HIGHEST HIGHEST per BORING ALL <br /> SPECIAL INSTRUCTIONS OR NOTES CHECK BOX IF Epp 1S t$NEEDED g FIELD NOTES- <br /> in <br /> o <br /> in ContalnerlProservative <br /> or PID Readings <br /> or Laboratory Notes <br /> 4 <br /> w <br /> SAMPLING • =°- <br /> 099 Field Sample Identification MAIM "o°" 4 Ln TEMPERATURE ON RECEIPT C• <br /> tlxt tc DATE TI✓VIE CONT <br /> w- <br /> [ I. ..oZ <br /> VQ <br /> [ _og <br /> { i ReQ*#Wby( ) <br /> low <br /> +WqurhW dY Isy�re+ni RacdwdbK(mal l Daea I! `- <br /> II I <br /> T17 <br /> RtlYquWrd ey{s�raL..y ReceMd br{SlgWre} �� �rl�F Doer II rr�r <br /> a <br /> DLSTRLL3UTi0N•WeilWRIMPIN9001.Gnat b Fk YWLre aid PIrrR b CJrt <br />
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