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ARCHIVED REPORTS XR0012496
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 XR0012496
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Entry Properties
Last modified
6/21/2019 9:12:27 PM
Creation date
6/21/2019 4:50:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0012496
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 Date 6A . <br /> RETAIL. ENVIRONMENTAL ENGINEERING- WEST Serial No Page of <br /> Site Address 93 7,— ,-y C:r'�H��jP") Analysis Required LAB- 5ell-__v47, '� <br /> WICf1 n h� �, C/ . l//1, CHECK DNE Its BOX ONLY CTIOT TURN AROUND TIME <br /> L4T) I (J �J L 7� yr 0 W Monaotkn8 ❑ 4461 <br /> Sheil Engineer <br /> r <br /> hon Pt is enveagaon44x1 24 hours ❑7l ��E \ax # ` 7f"L/7z po 46houra ❑ <br /> Sol!Clasa9yrOla ae! ❑ 4442 <br /> Consultant <br /> ryrName <br /> C&bl4 Address <br /> ddress +' C/f o Witter yp15daya <br /> Normallq5i / <br /> 4443C�l 0 <br /> 1 <br /> hor13 <br /> oonsultant onlact 7 Phone NO z -- So1VA1r Ram or Sys <br /> C J mO&M ❑ 4452 <br /> �!�Z/�U N 'go? N to NOTE Nottly Lab as <br /> ✓` L�`�/�Oil r /►i� <br /> Fax ��G' 7.2 i a0 Waler Ram or Sys soon as poadble of <br /> Comments -o O 0. 08 M C14453 24!46 We TAT <br /> 2 2 Q p� Olhar ❑ <br /> In in N I- m <br /> Sampled by /�-� CO CD a M "� o r UST AGENCY S v� - <br /> 0 <br /> Printed Name %c- r'�-� Lai U.1 a 0 OL LU arn MATERIAL SAMPLE' <br /> 8- CONDITION/ <br /> No of z _ sn E c m E DESCRIPTION <br /> Sarrtole �� Date Sludge So1f Water Alr conls m j `�' ti COMMENTS <br /> y �c) 04b <br /> - <br /> UZ- 3 �� 3 <br /> Relinquished re Prinled Name Date 6 Received(slgnaiure) Printed Name Date <br /> r Time Time <br /> Resin fished By(signature) 4�WdN m Date Received(signature) Printed Name Dale <br /> Time Time <br /> Relinquished 8y(signature) Printed Name Hale _ Recely d slgnature Pry ame Dale (p <br /> Time <br /> _ S (� I'1'\C f1 Time a ap <br /> THE LABORATORY MUST PROVIDE A COPY OF T_ C AIN OF U TODY WITH INVOICE AND RESULTS <br /> SHELL OIL COMPANY CHAIN OF CUSTODY <br /> AEV 411193 <br />
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