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ARCHIVED REPORTS XR0003741
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 XR0003741
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Entry Properties
Last modified
6/21/2019 9:04:10 PM
Creation date
6/21/2019 4:37:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003741
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 OCL PRODUCTS &MPAN ' <br /> Y cHAIN1OF cuSTODYR*ORD <br /> 4 . <br /> � <br /> ."�, 4�^" ®eS <br /> ,XCILITY ID-" ir r JAL" eons <br /> 7S7- p -2- <br /> 1U4aQ,Stet,D�} <br /> XiYekci tC SS lD A <br /> G <br /> I <br /> n � <br /> '}* �$S, rs I Z,5 7T CiVtlt 1 U �? i11�-IC Y ? i pr.f �r�q',I.r <br /> ♦ /� ' `� �+ ,4, (Q, lt7,ll�Ye� t. {47`] t• ,^' t a <br /> o CO IBC.t a l� 6 (� P— '1;'"' c-t "T�r �K�Sr <br /> 3 i�r <br /> rte ti,r 0 SolI Clast�]I fir► <br /> TURN AROUND- Select one ipnly � ',X �`i,, is,li <br /> n ' �' <br /> ear e sr �` � `� Q 24 hrs Q A9 hr; ® 15 days(Home '^ 'k", <br /> air Y� eisy, ' ' , 1 <br /> Analysis Required <br /> i t n <br /> to <br /> S RiTlma - - - Y_ --- -I cmnl�ry)rs D 1 57 -` w _' <br /> 1 . A til N r 1 + y' <br /> 1� U 61-- S fI n E t � °° m � v LAB USE ONLY <br /> m U w X cv -- =n uE `Lo r O ` <br /> UST ay_ Sample Time u v $ Z x m CO m y - H i p Lab Tracking No <br /> 8- d. N N m a a w a w 3f W <br /> FI�ld Sample ID (military) E -9 r z i i-- w I x z o <br /> C C a (L m >- a. o. a it cn o w Sample Condition/Comments <br /> c� a ca c� i- t- 2 m r- r l- t- 2 ] N � � O p _ <br /> 1-7 <br /> d 29 <br /> � C) �' t ' ` �► f r' <br /> U,q <br /> L- C C /`/1 o I <br /> V� 5 / (W f).K1 . J /_ CYo'o1 l.e.rsi.Temperature <br /> / act Uz- <br /> ,,,o i vt)e <br /> .�..w <br /> r <br /> Material Description <br /> R qulshed By signature) / Printed Name Date r I �'�f _�� Re iv (si ature) luted Name = Date q _ <br /> V J ���=�� At <br /> Time /1) IY L , , AlR h I+ e- Time <br /> i R lfnq 1 e By(slgnatuFe) 'Printed Name Date 4`Z� G1 r1 c i Y(si ature) Punted Name Date <br /> v rC 6 <br /> - �prily V l Time Time <br /> ng d By(signature) Printed Name Date_ Received y(signature) Printed Name Date 2 Ld <br /> • at/AI T)avu �S j <br /> Time Time i <br /> .� FORM BYIMTRAN THE LABORATORY MUST PROVIDE A COPY OF THIS CHAIN OF CUSTODY WITH INVOICE AND RESULTS SH LLC OFCUSTO Y <br /> ■ <br /> REVISED 12/97 <br /> J1 i <br />
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