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ARCHIVED REPORTS XR0003748
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 XR0003748
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Entry Properties
Last modified
6/21/2019 9:40:51 PM
Creation date
6/21/2019 4:41:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003748
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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. � <br /> HELL OIL COMPANY CHAIN OF CUSTODY RECORD <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Sorlal No: 970 feT - Fi page of <br /> ISilo Address: <br /> WICO: 2575 Country Club Blvd. , Stockton, CA Analysis Required LAB: SOP 4 <br /> 204-7524-3505 CHECK ONE{I}IOXOMY CUPT TURN AROVNDTIM[ <br /> Shell Engineer. , cw. Moolortne ❑ "At <br /> 9 _ Phone No.. 510 <br /> � <br /> 21 boon ❑ <br /> Alex Perez Fal - I6$ S�elnveerladlon ❑ 4"1 ��haw. ❑ <br /> Con it nl Nam &pdd[ess• >` sorclous�/Dlrpoeos ❑ us: <br /> $laine Tech Services. Inc. S W 16 days []lNorn+ao <br /> 1680 Rogers Ave. San Jose CA 95112 x wrier <br /> Consullant Conlacl: Phone No.; 408- = 0 1- c�°"�/D"Po1°l ❑ "" other p <br /> Fran Thie 573-0555 °' N 0° sol[/AkItemorsye. <br /> Fax • 573-7771 � � °O kn � oala ❑ us; ROM NeNy lob as <br /> Comments: CL- 2 Wd.rRem.orsye loan as roeer"W <br /> o •p :: 0 O a M ❑ a>;a WAS rue. ?AT. <br /> O 0 .n X <br /> Sampled by: -7T n N C r o = Olh.r ❑ <br /> _ m <br /> _ q 0 ° 0 C UST AGENCY: G <br /> 4 b a�0 O1 Q O i� C <br /> �_ C' d O a b ? 0 <br /> Prinled Name: 7, <br /> nd. w Ae [ 10 .0y O C M <br /> No of x x " .a0 c a ( MATERIAL SAMPLE <br /> Sample ID Dale Sludge 5011 water Air coni: r m j u ¢ v o DESCRIPTION <br /> ___ v a v COMMENTS <br /> Pot 7 Z 'i5 C C �/S 1-1 ra X X � or1 ,1 4 <br /> CA 712A"i3 wrdL*1 <br /> I <br /> Rvllnqulshod By(slgna ), Prinlvd oma. Dale y ' Racved(slgnaluro) Prinla polo- <br /> Rellnqulshed By(signature). Printed Name. Dale Rvicely (slgnalu Prinled Name. <br /> Time Date, <br /> r Oq nate, <br /> Relinquished By(signaturo) Inlad Noma. Delo Rac o gn r ) Prinlad Names pale. <br /> nmo - Time: <br /> W-Wa <br />
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