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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 10 . 59 FROM ERICKSON PACE 007 <br /> Stale of Rvs.nan Ageay <br /> tqi Approved awe No 1050-OM(Epplre <br /> s 3aaa� See Instructions on bads of page 69t54, �vorR.+r of T sub, tor* <br /> oleate pnnr or Tpe yFore�rro far r..a eAre f l2podi)yper..itrer omsaererh,wite Caf.Ferera <br /> 1 Gsniwult is US SPA ID Na mcirYfe�st Docvitierrt No 2 Page 1 fufo'^'a1'°"'^die hliaded a'° r <br /> UNIFORM HA211RDOU5 a not requYred b1r rid+�' <br /> WASTE MANIFEST CRD 9 8 1 4 5 0 4 5 4 2 3 2 2 4 of <br /> 3 Generoroes Nome wW MaRrig Address SHELL OIL COMPANY �' �C ►�E„” <br /> h HRZARDLUS UAwTE DEFT. <br /> P.D. BOX 4848 <br /> W3. a Gorierasor s Pham (714) 5.20-Z32 2 RNAHE I M CA 92$0:: <br /> m <br /> p 3 Tremeponar] GomPanY lta+ne 6. <br /> US EPA ID Nrwnber C 5"" <br /> a? _ D Tfsspgl7Rrs'R.dse•h- <br /> Z 7 Transporter 2 Compa.ry,Name 8 US EPA ID Nuirnh.ei <br /> V F Tteat1P�i�!Ra:_ `.�:,.; fir„{� :""r�,•.. <br /> Q 9 Deagnalsd F«dry Name and Sm Addrrss 10 US EPA ID Number Q- SkdL- <br />(D� RIC M1 <br /> �o <br /> — 255 PPR9 BLVD. CAD 2 0 9 4 6 6 3 9 2 � aa�y <br /> N� " r r Aaakwrp;a �?2 �Iqr E <br /> U 12- Contamen 13. Total 14 Ur#k �ti1 rG" f <br /> CI'Z 11 US DOT Dewr*Wmi(mckrdmg Pepper Shipp. Naas,ftaaord Ckss and ID Nw-b-) No I T Wt/i/d <br /> G37�' G @ I T P 8 5 lie P ► ! net " <br /> �f • "ff x r�''r3'? <br /> m <br /> R <br /> A �, <br /> O <br /> z r1t7� <br /> C <br /> fA <br /> to <br /> 0 13 Speaal Mar.RHV lnstruomm and Addhwid tofortnONN FACILITY: f <br /> ZAVOID CONTACT WITH SKIN/EYES SERVICE STATION <br /> LU 24 DOUR EMERGENCY PHONE NUMBER (800) 4249300 2575 COUNTRY CLUB <br /> STOCKTON, CA. 95204 <br /> ib GENMATCWS CMTUW.AT10N F haiady declare owethe eaeitanfs of the cans+Qninor+oro fully and aecwalefy described oboes bit PraPa "am an <br /> PPm$"am oro dasufied <br /> -CC p�� marked and lateied,cmd are rn all rospesas nn proper caiditian for trCMWOrt by high"y acro&V to apprKrtbio iedord,stab and eAarnariprtal lairs <br /> U <br /> If 1 am a for" giiannry 9encrnsor I ter*that I haw a pregrmn in place to reduce the WARM and tostaflr of Wrise gerarnard To Are degree I have delermmd to be <br /> � economically proclleable and that I have selecfwd the proo=ble method of tmorneN,rwroge or dnpamf cvrrenfly ovaloble to me which niaM MzQ3 the promw aid fumm <br /> Hthroat T4 human heahh and the wh.�ranniwYh OR d I am a ,mall gvonfiry g9neeawr I fia made a good farAi offort tea meienwr nny wash gerlerarlon e>r d mluct the host <br /> -asre morn emsnt method dxd is a.wloblo to me and tfiaf I can afford <br /> 0 d/TYpcd Name 5Y turn N BEHALF OF lilartlh pay row <br /> Y SHELL CIIL CO-lQ 15 0 3171.3 <br /> VT 17 T ms 1 Aeawwbd men,of Rech of hnafenah <br /> Z a P e MorRhh Day Tear <br /> tic <br /> N <br /> Sr- <br /> LU S <br /> r <br /> a 1 T rfer Acknowkd email of Races i of Malerhah <br /> TPnnfed/Typed Namc Srynaluto Hoists Day Yeor <br /> 0 i <br /> LU N 19 01—vparYey Indtearran Space <br /> Q p <br /> V A <br /> � C <br /> f <br /> 2Q Farll Omer lcanart of reeet of he-90 maend o"fed <br /> F er rata,Ccraf <br /> bw fiK ewmfs a SMMM as rioted m hen+ 19 <br /> T Pnriled ,pod Name srgame� Montt. Day Yaa. <br /> 29475243505+3982 BYRAM DO NOT WRITE BELOW THIS LINE. <br /> Whirr TSDF SENDS THIS COPY TO DISC WITHIN 30 pars <br /> OTSC 0022A (12/9t) TO P 4 f o: 3000 Sacramento, CA 95812 <br /> @PA 8700 —27 <br />
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