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ARCHIVED REPORTS XR0003533
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 XR0003533
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Entry Properties
Last modified
6/21/2019 8:29:56 PM
Creation date
6/21/2019 3:56:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003533
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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SEP 1 ' 95 1Q 5B FROM ERICKSON WAGE 006 <br /> Stare of Cesfort"rrn„n y,,,at Preleenon Agerq See InstrVetlarfs on back of page 6 DepamncmR of ToFKSuberawees CoMo <br /> Form Approlled OMB No 2030-4G39(Expires 94SacramSacramento94) r Sacramento Co#Fo~ <br /> PF,ara Pr"++N type Fenn des.y...r!«.ws en afire 02v;rc&? <br /> I Generator s US EPA iD No Mamlml Document No -2 Page 1 lnfar <br /> 7Aencxfim m the Bladed aces <br /> UNIFORM HARDOUS a r+at re'q"i1dd by gyral krw <br /> WASTE MANIFEST 1 4 /— rs c '211 2 1 3 of 1 <br /> 3. Ce eratals Name and N.M; +g Address 5HE1..L till COMPANY A State Manifest 0000"0014umbiler" }n..."". <br /> +� HAZARDOUS WASTE DEPT. <br /> so P, d. BOX 4648 & stare�etlal�rs ,},y �>; ✓„ <br /> K a <br /> rn 4 Gc++eratorrs Plnons i ) _ , 7 <br /> 7 • M o <br /> ca <br /> CS 5 Transporter 1 Company Nome C DA FAD / e S+ote TrramparUers 10 s <br /> J T Transporter 2 Colnpo+ny Namt-- 8 US EPA ID Number E State Ttanspofte-5 to 4;,r,p <br /> V F TronsporEeds Mane <br /> Q q nes2nowd r X liry Nome and Sne Address 10 US EPA iD Number Cf Sta*e Fao7hy's 10 <br /> Z <br /> o ER I CKSCN, INC. - D a <br /> 255 PARR BLVD. C A D Q Q 9 4 6 6 3 9 2 <br /> 17a <br /> (JRICHMOND, 12 Corttaeners 73 Total <br /> 14, Unit <br /> 11 US DOT Iasxefphw+(inc4r6a+➢F+roPeT ShtpFrng Hartle Resort C7ors.and ID Numbed No 7 QuorttllY Wt Yaf <br /> r <br /> a Q Q 1 T P Q 1510101 Q P <br /> C-4 <br /> E <br /> go N b = <br /> a? E ` <br /> R <br /> A -4� <br /> T � <br /> m O <br /> m <br /> R <br /> LUZ <br /> LU <br /> 0 15 Speaal tcer149 krart►cltara ar+d Addmasal Infwtneeior+ <br /> FRCILiTY: <br /> C AVOID CONTACT WITH SKIN/EYES SERVICE STATION <br /> Z 24 HOUR EMERGENCY PHONE NUMBER (800) 424-9300 2575 COUNTRY CLUB <br /> = STOCKTON CA. 95E04 <br /> 18. G eNMATOIrS C MTIFWATION• i here*dociare rhes It*cwAeah of the cvns+ptn++ertt aro fully and accurately described aba+e b7 Pyr sh ppm nam <br /> 4 Packed marked.and labeled and are.n all respa7s m Proper condWtoo for Iran, #I by highway acmrdmg To app{Icabla federal slate and rr+tematror d <br /> J If I a...a forge Roan"gw"amf 1 cerofT +het t%a ie a program m place to reduce the velums and to mny of.ware generated to$se degree 1 hate be <br /> eae.+o.nr.cally Pr«t.+caklla and the i ho"seiee+sd the le—theable method of heohnere 00rage or disposal eurenitly ara11o61e fa the.rltlelt mtrtlrttltss the <br /> thmot to human I eahfi and the ermror,neny or how made of 1 am a small qua+hfy generatI homode a good faoh effort to mmmtoe my Waste g9narmtw+ bttFt <br /> -a"nivartoammenr method that rs a-04ble to me and that I can afford <br /> O /Tra+d Naa+e ON FEHAL+F OF Year t <br /> F L.,�A )e117,�- SHEL' OIL CO. v Jr 9 <br /> tJ TT Tr 1 Ac ement at R9crn t of Materials <br /> � r e Hoath Y <br /> W N P RNL A <br /> &U 9 r <br /> W <br /> 0 1 <kno.rled +of R"cI T of Malerwls <br /> zz <br /> Year <br /> T Pntaed/Typed Name S.grrature Month <br /> 0 Q <br /> W 19 Drscrepancy lndtcotion Space <br /> U p <br /> Z <br /> C, <br /> 1 20 faclFi pryer or aror ficanon of reser of halorda+Is materials co.ered tfi,s mcmfasl es<P l os noted m Item 19 l <br /> Morph yem <br /> T Prirlted�Nome S'g'i 101 1 (��y <br /> 20475243505+3982 BYRAM DO NOT WRITE BELOW THIS UNE_ <br /> HVh1w TSDF SENDS THIS COPY TO DTSC WITHIN 30 DAYS <br /> DTSC SW2A (12/91) To P O Bou 3000 Sacramento CA 95812 <br /> EPA 9700-22 <br />
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