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ARCHIVED REPORTS XR0003742
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 XR0003742
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Entry Properties
Last modified
6/21/2019 8:55:38 PM
Creation date
6/21/2019 4:38:41 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003742
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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r <br /> ELL OIL COMPANY *CHAIN OF CUSTODY RECORD Dale: -q? <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serlal No: Page I of ;,) <br /> Silo Address; Analysis Required LAB: vi <br /> bt57S louYl GIU,b SIUr� ��oCJ� Z �Vb <br /> . IC i204- 7�r]�� ..2 s� tb CHECK ONE(1)ROX OntV CT/D1 TURN AROUND TIME <br /> l v` J G W MonRarinp ❑ 4111 24 hour ❑ <br /> Shell Engine�e,�r�:.pz- Fd Phone i o.: 510 <br /> U�7 SR.lnr.rtlydlon 411) <br /> )� �1+ Ishoun E) <br /> Consullant Name&Address: sou Chuegg/Dlrparal ❑ s143 <br /> � lidays WiHorrtwll <br /> Cambria, P.O. Box 259, Sonoma CA 95476 Wnl.r ❑ <br /> 413 an.r <br /> Consultant Conlacl: Ph# 707-935-4854 Cbrriy/D4po�a� ❑ <br /> Joe Neely Fax 935-6649 oo o�1M R.rnoriyi ❑ <br /> NOTE, Na ft lab as <br /> a, Walq Rom or lye soon as Moisk"of <br /> Comrnenls: �, O■M ❑ 163 24146 hn TAT <br /> 0 oco <br /> 2 2 = O�h.r ❑ _ 33 <br /> Sampled by:JOU o r 5 <br /> g Q co E� U. a UST AGENCY: <br /> Prinfed Name: �� a ° 0, <br /> tr — .° .a t '� n MATERIAL SAMPLE <br /> Sample ID Date Sludge soil Wafer AlfNo a 0 a' E CONDITION/ <br /> cantst � � � ° � o �' o DESCRIPTION <br /> m > U uiL U COMMENTS <br /> it-be,17 <br /> M w -l y-15,(r <br /> H� <br /> w 'i W -3q 1� <br /> Ranq gna e): Ptinled NData: �a Received( fl tine). Pill d Name <br /> NN K. Ec <br /> R my gnatura): Pled Name, � Dole,• Received(dgnature) Ptlnled Na a <br /> a Time: <br /> lRar0*466a By allxe): Pdnfed Na . Dela: ReceivenGlum): Prinled Name Date, -! <br /> 311Y MUST PROVIDE A COVY OF THIS CHAIN-0E-QU;jQDY WITH INVOICE ANQ BESULIS <br /> 14Tnr: ! 1 S TITITe: <br /> 1rwcdcm N Wmr <br />
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