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ARCHIVED REPORTS XR0003738
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 XR0003738
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Entry Properties
Last modified
6/21/2019 9:12:36 PM
Creation date
6/21/2019 4:35:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003738
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 OIL COMPANY CHAIN OF CUSTODY RECORD aale.'�-�2— <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST serial No. O-- 1-7S— �- 4 - Page o! <br /> Silo Address; 77 <br /> t�� 2575 Councr Club Blvd. , Stockton, CA Analysis Required LAB. ��5`f�'�t,10 <br /> wIC#; { <br /> 204-7524-3505 CHECK ONE(1)IOXIONIY CTJDT TURN AROUND TIME <br /> � ,0 <br /> ll ❑ <br /> Shell Engineer. Phone No : 510 G W Slonloa Ilii ]I bean ❑ <br /> Alex Perez jFc3W.-'6'M A sM�617 2 rnv6dlatlbo ❑ 4'"T AIhoun ❑ <br /> Con I! of N m & Adci ess. O <br /> p a gg rr P, Sol C6"vy/OWpor.1 ❑ 4442 DO }6 days ❑(Normaq <br /> Mine Tech Services. Inc <br /> 1680 Rogers Ave, San Jose CA 95112 X wat.r <br /> w ` Glarrlry/pppo�al ❑ "43 Olh�r ❑ <br /> Consullanl Conlacl. Phone No., 408 � 7� <br /> 573-0555 c•, (� IIs] <br /> Solr/Akgem 1 rsy. <br /> Fran Thie Fax # 573-7771 a o 4 Ln NOTE Na1llyLob ar <br /> Commenit, j N t^ Romo[ <br /> O I Sys ❑ 115] soon as poulplr ar <br /> Y1� l 24141 hit TAT <br /> o o �; 0 x I <br /> Sampled by, `" d o o r- <br /> $ m co rn a o h o m UST AGENCY. <br /> Prinled Name: !�< < rc- <br /> <� W a 5 o c a 11 <br /> SAMPLE <br /> No of 'c x x 15 a E K 4 C a E MATERIAL. CONDITION/ <br /> Sample ID Date Sludge Sol] wale( Ali = � � a o 4) o DESCRIPTION <br /> II canis >7f m > °' U O 4 U a` U �� COMMENTS <br /> jl <br /> Relln wished fy(slpna ), Pt[la,� Dale Received (slgnalure) Pr! Nam �I Dal <br /> Re In e y Qnat e) Prinled Name Dolo RnceNed (sl9patura) Pf! od Noma 1� pa <br /> Tlma �ieKGc 11.rd+fY�%, I�c)orr'ti��i Time <br /> Ralln shad (slgnaluto) Prinled Name D610 RocoN d(signature) Prinled ame. 1 Dare <br /> nn,o I n11� rne <br /> THE 1,6URAWRY U5 13 iJAl_N QE_C11ST4RY 1YIT}I t II <br /> II II jh"Ot NCunay <br />
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