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ARCHIVED REPORTS XR0003743
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 XR0003743
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Entry Properties
Last modified
6/21/2019 9:32:03 PM
Creation date
6/21/2019 4:40:24 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003743
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 oat©: 'zlZz�9? <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Soria] No. 2 L 7 11-- •= _�. Page i of / <br /> Silo Address; <br /> 2575 Country Club Blvd_, Stockton, CA � Analysis Required LAB: �EQuo%9 <br /> WIC# <br /> 204-7524-3505 CHECK ONE(1)SOX)ONLY CTIDJ TURN AROUND 11ME <br /> �u <br /> Sh©IE Englneor. G W MonRoring ❑ 4"1 71 houn ❑ <br /> Phono No.: 510 �, <br /> Alex Perez FA,P-6168 �� SReInroslipolon ❑ 4411 a�haurr ❑ <br /> Con u�l n1 N c%&SAdd ess- �� �..� <br /> Q { Inc. o Sam Ckmvy/nkposal ❑ 4417 <br /> eine ec ervices, � � 16 days �l(Hom,an <br /> 1680 Rogers Ave. San .Tose CA 95112 X r wol.r <br /> Ow C�, ClwsYy/Dkposol ❑ 3 Oth•r ❑ <br /> Consullant Conlacl: Phone No.; 408- .� <br /> 573-0555 N N SoR/AlrRom orSys <br /> Fran Thie o tO � ° C144Sx NOM Haley lab as <br /> Comments: <br /> lFax # 573-7771 <br /> m <br /> 6 _ � Wo1s'I Rem.at Sys soon as/osulble 01 <br /> i] N +vi aGo O IL C] 4433 24142 his IAT <br /> O O O ., <br /> �Eo V Z Olhor ❑ <br /> Sample[!by: �`� o o m rn °n o I` m � } <br /> .� H `� � UST AGENCY: <br /> b a p o b s N a N �� <br /> Prinled Name: Vim---• �'�4 a M. 0. m I' 2 O <br /> ° .n kuo a. ISAMPLE <br /> 11 SAMPLE <br /> E$sn � ID Data sludge son wafer Alr No of x p DESCRIPTIO" N CONDITION/ <br /> j jcant: <br /> COMMENTS <br /> _ Do,,• <br /> Ll <br /> IL <br /> vinqu!>had By{slgn (e): Prinlad Name Da10 Race (sl nal HMO a II pala� <br /> limo ' !/ G��!� <br /> 'q yt ad 8 sF r Prinlad Noma. Dalooeo vod (slgnalura). Prinlad Name. �I Dale, <br /> Time/ 11 Time <br /> shod By, Prinlad Name— Dale 4 jRoc9jKd(slpnal Prinlad Name. Do 2 <br /> nm. ]E `ir In <br />
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