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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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Tags
EHD - Public
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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dale <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No page of Z- <br /> Srtez.575, C -.f r C[mob �;[vd �,. �({�r, Analysis Required LAB ��� ----- <br /> WlC# - - ��----- -- --- - - - -- - - - - -- - <br /> -7 _ "� CI IECK ONE(t]BOX ONLY CTIC TURN AROUND TIME <br /> G � � N �� (0 -r � O W MnnAorin <br /> Shell Engineer — phone No y rC� a ! 1 4461 <br /> ^1� F� 1 4441 24 hours ❑ <br /> r ��1 r' V\ Fax # <br /> She Invesilpatlon <br /> Consultant Name& Address - -- - - Soo Classily0sposal [_1 4442 4e hours <br /> Cl <br /> a <br /> N <br /> Q Waror 15 days I l (Nora al) <br /> L r� �— Claaelly0leposal f I 4447 y <br /> ConsultanCo <br /> t ntact phone No 116 Uiher <br /> / til�I`� f � T�1'Z y!ra N is 0 r� 08?A4452 <br /> rRom orSys <br /> J. ( 1 // <br /> ! Tc-{ l�•�r( � Fax # 791, 76 3a ro m N <br /> Comments -- -- - - - --- - --- - D 00NOTE Noiliy Lab as <br /> Q us Watar Ram or Sys <br /> t40n as Poll BUS o1 <br /> 0 CL O 6 M i 4457 24/40 firs TAT <br /> U.1 co <br /> Sampled by — _—___- --_ _— _ in in o 0 r aner-_ -- ---- --- — <br /> 0 0 cc � � 1 m � -- <br /> a a aa. E, o cn UST AGENCY 5'a.,T' <br /> CD <br /> Panted Name �c , �i J w a. Om c � '^ -- SAMPLE <br /> ° �, MATERIAL <br /> Sample ID Date Sludge Soil Water Air CONDITION/ <br /> P 9 Noof <br /> �' c m E DESCRIPTION COMMENTS <br /> — --- > tm cs ¢ c� <br /> P X11- --- - - -Z - - - - - - --- <br /> CfT 1Z W --- <br /> c f T- 13 - - <br /> C )PT / 9 w - -� <br /> J-1 <br /> ilr Iur Ins gnalurr) Printed Nati / Data i z&4,y ecerVdW,, <br /> arur� n Prrnle Namfl Data�L f3a �j r <br /> >Z fin w.h sf n iture — - •C 1 _— -- Time _8 / <br /> Y ) Prin amc pate/L 3G f; ved S,9net - -- - - - <br /> t — _ ( Panted!Jame Date --- <br /> - a tz . _ Time t-,J' [1 Time <br /> quis ed signature) Printed Name Dalo Receive ignature} Panted(Jame— -T-- --- - <br /> 1 - - 1/ Date <br /> 1 __ _ Time Time <br /> --- THE IABDRATORY MUST PRDVIDE A COPY OF TNIS'CHAI (' - rr`r` -~~ <br /> _ —__ ___ _ OF CI TODY WITH INVOICE At�D <br /> REV 411!97 _ _ --- --- - -- -- - t/ - --- --- �E%C IS <br /> 0 0 SIIELL OIL COMPANY C*CUSTODY <br />
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