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ARCHIVED REPORTS XR0003533
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 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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SHELL O i L COMPANY- ------____ �- �- �-� <br /> CHAIN OF CUSTODY RECORD Date � `1/73 <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST — Serial No Page Zef Z- <br /> 511e Address <br /> 5 ?, �,., <(��� l ` k�� Analysis Required LAB _ ,�„ <br /> wlca — –- — – - — <br /> �JLf c� r ��L,� v ClIECK ONE(1)BOX Y CTrpT TURN AFlDUND TIME <br /> z <br /> OW Monladng I] 1151 <br /> Shell Engineer Phone No 24 nous 0 <br /> Q, <br /> /L,,- //� G )7 - G f l sits invec,lpatlon 441 ❑ <br /> fQ, 1 I V Fax # v 1 h � 11 ,� sor cla66lry,a6�eal ❑ /442 <br /> 40 howl <br /> Consultant Name & Address f',�4 L����f L C, <br /> ' r c r o 15 daysKIN <br /> oinu!) <br /> I I I �f R 7� 7.� Water <br /> ` - c[ l ✓� / C' �C�U�Y Y� !f�- ---- X ` ClasslfyrDlepoeal U 4117 other <br /> Gonsu lanl Conlad _ Phone No q14 <br /> _ l r SoWAIr nem or Sys <br /> y .T tT} DAIA ❑ 4452 <br /> Fax # :rG l 3 to °d R�' NOTE Nntly Lab as <br /> Comments - � 1n Water Flan►or Sys loon as posoba of <br /> v -0 o r► o ; o a M U 1453 21uti hs TAT <br /> o a LU o0 <br /> Sampled by 1 _ to o E W a � 0 eller ❑ <br /> / " —� m o co at S V to >- UST AGENCY. I`u Tok lh 61 <br /> P O d <br /> ti <br /> Printed Name _ �� , ��r�� (L a_ w - �� a or <br /> ul w m N ,�-� MAI ERIAL SAMPLE <br /> f Na at u i'u °' CONDITION/ <br /> Sample ID Data Sludgo Sod Walet Alt Collis 0 Im IJESCRIP rIDN COMMENTS <br /> CL _ <br /> 0a) 10 <br /> Rel uishad nalureJ Prinled Name w �+ Data 5q.5Ile wed Zjg n- 6' PtlnLe44game Dais S <br /> a S 7>i)✓,J Qoiji-s / Time 7'�T.fr�// Time <br /> En <br /> Fq-,A-sBy of nalureJ Prlpl Name pale,. S�/J nece {tlpnalure Printed Name Deie <br /> YfU)C// T!me 6 _ Time <br /> signature) Pinned Name pale Ile lv slgnalure) Pnnied Name pate <br /> limet� Time <br /> THE LABORATORY <br /> -MU—ST PROVIDE A COPY OF THIS CHAIN OF U ODY WITH INVOICE AND RESULTS <br /> nEV 411193 SI IEkL OIL COMPANY CHAIN OF CUSTODY <br />
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