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ARCHIVED REPORTS XR0003749
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 XR0003749
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Entry Properties
Last modified
6/21/2019 9:21:07 PM
Creation date
6/21/2019 4:42:40 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003749
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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i <br /> Ah <br /> SHM OIL COMPANY CHAIN OF CUSTODY RECORD Date: 7/,? 97 <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serlal No. Page l of-,L <br /> Silo Address: <br /> 2575 Country Club Blvd. , Stockton, CA Analysis Required LAB: SEQ,401A <br /> WIC#: CHECK ONE(Il Box CT/01 TURN AROUND TIME <br /> 204-7524-3505 <br /> Shell Englneer: 1Phono No.: 510 G W WnWng ❑ 4441 <br /> 24 hour ❑ <br /> J41-- 168 316Inv6slladlon ❑ 4411 48 hours <br /> Alex Perez ❑ <br /> Cont�lc�nl N�mt & ddress: Inc. SolCla"Vy/Dkposal ❑ 4442 ❑ <br /> a ne ec ery ces. lb days (NormaD <br /> 1680 Rogers Ave. San Jose CA 95112 XWO}eraLp444J <br /> Ivic <br /> Ckwity/ osai ❑ Other ❑ <br /> Consullanl Conlacl: Phone No.; 408- 14 <br /> 573--0555 �' N Sc1VArRom orSys. ❑ 44s2 <br /> Bran Thle Fax 0• 573-7771 0 d t O&M_ NOTE Notify lob as 1 <br /> ( D o. Wd6r lora or Sys. soon as/oulbl6 0l <br /> Comments: q N y 0 O i s4 C] , <br /> 24148 his TAT <br /> O <br /> (3 Z Other ❑ <br /> Sampled by: 0 <br /> -0 o c <br /> C) toM . <br /> UST AGENCY:� o <br /> 0 16 <br /> 10 r <br /> 7Printed Name: ww �P a. MATERIAL SAMP <br /> -- o o CONDITION/No,or x w L .a aDESCRIPTION 1D Dole Sludge Soil Wales Air °conls U <br /> X. u COMMENTS <br /> -7/y w 3 X X <br /> F <br /> mow. y 3 k <br /> �� ~s 3 X x <br /> mow _ ? 3 X x <br /> i <br /> Ynqulshed 8 gnorwc Prinled Name. Date Received ro}. PrinledbLunw. Dale- b <br /> G-� Time <br /> Piln:ed Name,_ Dole 44z1b Roce d n lute). Piinled Name. Dole, <br /> Time Time <br /> 'vd slpnalure). Ninlad Name. Dale Rocolved(sldnolute) Prinied Dale 7/o 4-7 <br /> limo Azz Tlmo 7' -7 <br /> /W q aw M iMbel <br />
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