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ARCHIVED REPORTS XR0003545
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 XR0003545
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Entry Properties
Last modified
6/21/2019 8:17:22 PM
Creation date
6/21/2019 4:11:34 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003545
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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CALSCIENCE ENVIRONMENTAL CHAIN OF CUSTODkCORD " <br /> LABORATORIES, INC. 0/,?0/7440 UNCOLN WAY Date. <br /> GARDEN GROVE, CA 82841.1432 q�9 <br /> TEL; (714)995594 <br /> 494 • FAX: (714)87501 Incident iso, � Page <br /> LABORATORY CLIENT Kiif Analytical,LLC CLIENT PROJECT NAME r NUMSER, a,e-Ne-COC Me,) <br /> ADORESS 720 Olive Drive Suite D 5 7 5 C owm Y G L,u a 3L v o 5T xrw IPa a//3 <br /> PROJECT CONTACT LAO IN ONLY <br /> CITY Davis STATE CA ZIP 95616 D d W� ® ' n) <br /> SAMPLER($) (SIGNATURE) OOOLER REQEIPT <br /> TEL $30-297-4800 F' 530.297-4803 E-MAIL TEW ,C <br /> TURNAROUND TIME REQUESTED ANALYSES <br /> ❑ SAME DAY ❑ 24 HR 72 HIi ❑ S DAYS 1110 DAYS <br /> SPECIAL REQUIR11MEWS 9WITIONAL COSTS MAY APPLY) 1 <br /> ❑RWQC8 REPORTING ❑ ARCHIVE SAMPLES UNTIL 1 I o Q <br /> SPECIAL INSTRUCTIONS CD o <br /> �» <br /> Lo <br /> � p m o _Z <br /> W v t3 `v H as C 9 <br /> SAMPLE ID LOCATIOWDE$CRIPTION ��AfrIPLt� VATIC auir � w m s y a tea '$' u�i -9 a. � c�a x <br /> 04 <br /> 011.6 at 3-00 Hw <br /> Reu�qu .d br( ture) RSaelved by:(Signature) Date. Time. <br /> Resnquiahed .(S)WOU49) Received b)r(Signature) Date Time. is <br /> Rounquished by.(Signature) Rarelved for Laboratory b)r(Signatur <br /> Date Time <br /> z;&Ape - I /4?/,V/ , I d <br /> DISTRIBUTION.Whitt with Mal mpmt Green to Fila,Yellow and Pink to Chant 10/01/00 Revision <br /> Placa We that pages I and 2 of 2 of our TIG ate printed on the mvem We of the Yellow and Pink copies mspeglve <br /> y. <br />
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