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ARCHIVED REPORTS XR0003525
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 XR0003525
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Entry Properties
Last modified
6/21/2019 8:03:16 PM
Creation date
6/21/2019 3:52:30 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003525
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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6 +(a>w <br /> LL OCL COMPANY CHAIN OF CUSTODY RECOD Date: <br /> l RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No. 17c00) ?-2! -2S_ _ � _ Page of <br /> 5ile Address: Anal sls Required LAB- <br /> 2575 County CZuh Blvd. , Stockton, CA Y q �=�-- <br /> A1 ZFT- <br /> WICI: 204-7524-3545 MCC GAL(1)lox ONLY i cupr TURN AROUND nldt <br /> Shell Engineer: Phone No.: 514 jaw Monlak+o ❑ 6441 24 hors ❑ <br /> R 10 6rra ,Len-w FdVi. 6168 SRrrnro wcolon [] AM /shwas 0 <br /> J <br /> CanIsotic . <br /> aQie , Tc. + n. o>ai e+ <br /> ery :aay. ❑wam,aqe � es ,a <br /> 995 Tlmorhy Dr. San Jose CA 5133 c��srfowQo+ai ❑ 14i3 (Xb*l <br /> 0— <br /> Consultant Coaifacf: <br /> JPWc��ly� 408 ❑—•• N [V °a soil/AY Rom of sra <br /> Fran Thi.e Fax p• 293-8773 ° ° co n °' ❑ 4SS2 Hort HoWlob as <br /> 0 D Wolof Rom,w Syn faon as roid0lo o[ <br /> Comments. ro N w om G&sr ❑ SJ13 ?I/u hf. IAT <br /> 1 ll 4 � Z Olhor ❑ <br /> p T. 1 <br /> Sampled b b ko m , ° o Oi o UST AGENCY: <br /> Pnnled Name: o p ° o a a SAMPLE <br /> No or x X T �, E r a. E MATERIAL CONDITION/ <br /> Sample ID Dale Sludge Soil Wafer Ali „� .. o �, O a �' O DESCRIPTION <br /> conte (s Q U a U COMMENTS <br /> qU13 x ` <br /> If <br /> W ' �� tate Timet Inti 5 . <br /> 1 <br /> — 1A v, Is <br /> No )nits <br /> ;Mtn <br /> ed By(dUrvahu hInled dam ��y Dole -�-( Re a ( naluio). Pi nl N ma- Uafe 1 <br /> f�J n e � <br /> y( ). Printed me. Dale Rec lv a Ps o N n Do o <br /> Ttmo� I 1lmo. <br /> ho $y(signature). hinfed ame Dole Re d( gnalure) Printed Nanw. Dale. <br /> 111F 1ABORAWRY MUST PROVIDE A r.QEY QE 11111 QlAIN QF 901012Y JY1111 INVQICE AND RES9115—- <br /> iimQ Ttrs►a. <br />
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