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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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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dale: <br /> RETAIL. ENVIRONMENTAL. ENGINEERING - WEST SeElal Na: Page I of <br /> ISIle Address; �s `t nr+,r tr Cl cr�� �31v Analysis Required LAB: <br /> • CHECK ONE 111 Box ONLY CUM IUNN AROUND ME <br /> 204-- 75 L�`/ -� u;� <br /> • c W Monloma 4461 76 hoes ❑ <br /> Shell Engineer; Phole No.: 514 (141 <br /> /! y^r, ;S U^y v ON•Invedigarlon Cl <br /> I� 1 eA Y_L -5 6R haun <br /> 11fax �!• <br /> Consullanl Name A Address: 6aRCbaruylnMpofal 466: 1Eflayr ®1Nofma4 <br /> Cambria, P.O. Box 259, Sonoma CA 95476 WaisllylDlrporo1 17 4643 olh.r [D <br /> Consultant Conlacl: Pty# 707-935-4854 � w � SWAN Rom of Sys ❑ 4663 <br /> Joe Neely Fax 935-6649 ar °i"" NOTE HolNyldbm <br /> Wd.a Rem.of Cyr Croon as/osgue at <br /> r1Ytlenl5: .d .d � yU� � � o a 1� C] usi a61u hrs 1A1 <br /> x Z Other p <br /> Sampled by; J/1. % o N cUST AGENCY: <br /> o <br /> N <br /> M 1. <br /> 0. <br /> Ck <br /> SAMPLE <br /> Prinled ame: Jc* � t� <br /> o .I a E MATERIAL CONDITION/ <br /> Sample ID No.o1 x a~ o o � a DESCRIPTION COMMENTS <br /> Dale Sludge Salt Wahl Air carols on ro- U U A. U <br /> Alt", `/I A Vt7 <br /> D1w- z - <br /> X 12 51 <br /> 1mv 4z )M <br /> R 0 gna a): Pr n a Na '.''n�• + Date: I1-[r fiaillacelved <br /> Roca gnalura): Pr nl <br /> C C c I[vc 11�x�ts U 1104 <br /> R !y(dgn luta): Prinl Name: Delo: W(/ ( nnaiu�e: Ptlnled l�arrw: a. <br /> flaw: <br /> Rakgtrl hid P61n ed Mama: Dale: RecoNed(Nlgn re): Primed Name. Dole,j�-I! � <br /> wnel— '4n/l.t.. trw►v�� ! JV ilrrw: 12-5 <br />
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