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ARCHIVED REPORTS XR0003739
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 XR0003739
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Entry Properties
Last modified
6/21/2019 10:00:22 PM
Creation date
6/21/2019 4:36:00 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003739
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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Fg���ETAIIgELLOIL COMPANY rCHAIN OF CUSTODY RECORDL ENV - Serial No: `I-aa127 - <br /> IRONMENTAI. ENGINEERING WEST . _ t-- page 3 of 3 <br /> Site Address: <br /> ''r r 2575 County Club Blvd. , Stockton, CA Analysis Required LAB: __ S��Q40;� <br /> YYICO: r� CHECK ONE(11 IOX ONLY CT/DT TURN AROUND TIME <br /> 204-7524-3505 <br /> G.W. Monlo&V ❑ "ii <br /> Shell Engineer: Phone No.: 510 24 how+ ❑ <br /> 7 {7168 Q SO* 4"r As hour. ❑ <br /> Alex Perez F&7 : - f ❑ <br /> Con�T�llainl "?mec% Add�ess• 9 Soil CkwXy/oirpo,nr ❑ ue2 <br /> a ne ec ery cos, ince � 16ar:yr ❑(Holman <br /> 1680 Rogers Ave. San Jose CA 95112 X cc water <br /> O w ClasrMy/I)Lparpl ❑ W3 other ❑ <br /> Consullanl Contacl: Phone No.; 408- <br /> Fran Thie 573-0555 y L to cd OAA R.rnorsys. ❑ usa <br /> 1FaxN: 573-7771 ) Q U') Mort! Nonry lob as <br /> Comments: �,�r uo � N v o: R.� orsri. E] �s� roan nr rorrrbl.of <br /> GU4 24!48 hu, TAr. <br /> 4 o O <br /> U q Z Other ❑ <br /> Sampled by:, LO Ln o n , <br /> g m a o CL <br /> 0 o �" o (D UST AGENCY: <br /> N <br /> Printed Name: -�{�►'L -�y�r 7'`� � w �' a k a � o MATERIAL SAMPLE: <br /> No.or s z w -6 fl E ° CONDITION/ <br /> Sample ID Data, sludge Sou wafer Air cont:. ,�' m j a+ (j Q U U DESCRIPTION COMMENTS ' <br /> RJ Z y5q CC <br /> 2Cj7ZCC C\ <br /> zq(gx <br /> ccr�i� � X _ <br /> Rellnquls a Y( n to..: Prinlod Name: Dale: Rnc (slgnalur Prinlod Norna: Dara; /•Z� 4 <br /> 5-x Smr Tlme: / vf! G-5'�vrZ. ' ,�✓/J� y <br /> Rolln y( gna PT4n1ed Name: Dale: t Recetved(signature): Ninled Name: Dale; <br /> Time: <br /> Rellnqu[shed By(signature): Prinfad Name: Dale: RacQfv9d (slgnalur Prinlod J Delo: z9 <br /> — Tlmo: Tlma: <br /> - •..1 p Uri M(.�bdt <br />�� wrr�,r�w.rwirrwr. <br />
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