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ARCHIVED REPORTS XR0012496
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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 COMPANYCHAIN OF CUSTODY RECORD Date 195 <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Serial No Page ? al 2 <br /> Sil �Address <br /> C �-�Y'r �1��?�il v � L k --- -- Analysis Required — — - LAB. _Sa <br /> - <br /> v U!h <br /> WN — ci[ECK ONE(t)BOX ONLY CTrDT TURN AROUND TIME <br /> 76)r-` S 4��" j C> t� 0 I Monioiing ❑ 4401 <br /> Shell En T <br /> eer rFia, <br /> t xNo 5!�� v 24 notes ❑616P16� Sko lnvesllpauon4441)�' l?7 Soo Clasoilioisposal ❑ 4442 ,a nous ❑ <br /> Consultant Name & Address f o <br /> �" l•"v L� > o wafer 16 aey, ��Norrint} <br /> 1/) G v /✓ 4 ,Sf'4,, G 5 °D clasell rote sal ❑ 4443 Other cl <br /> -Consultant Contact PhonA No 716 12 SolVAlr Rem of Sys <br /> !� o a M ❑ 4452 <br /> LtG , " ? � '" 7St °1 CL)i °n NorE Nolllyr_&bes <br /> G +�K ]Fax # — 0 Q in Water Rein or Sys soon as poselhle of <br /> Comments 'a - 0 CA,< a O&M ❑ 4453 24149 No TAT <br /> � � Q uT co <br /> `o a Diner <br /> Sampled h Z,� tom_ _ in `� o 2 N ei " 1-, <br /> P y ata 00 a $ o r LIST AGENCY. ,d J�1G , ,� <br /> E_ <br /> o a, <br /> Printed Name_ /A I G � eK 13,/, _ w n, w 0 n 0 C a 'A MATERIAL SAMPLE <br /> T — s� E A C m E DESCRIPTION CONDITION/ <br /> N6 °I <br /> Sample ID Data Sludg° Sod Water Air cants la COMMENTS <br /> (�3 - - - - - - I Doo <br /> Lf <br /> Lt - - - -- -- - - - - - - <br /> 100b <br /> R ulslla st naruTp P led i e �— Date�/J 8 F_� acei d( I ►atyray P In d Name — Dale, <br /> r rJL � J I Timee , LL <br /> I n t l�c� — ` U l UeTime <br /> el n uts 9 qy gna I PlY0 Name Date s/� [.� It c ved(sfgnjht ) Printed Name Dale, <br /> \ � <br /> Tillie LO — ---1— — Time <br /> 1 �} nquisiled to gnature) i'rirt ed llama U'lid — ITecely (�sltgn tura I Pn ad a a 1 Dale <br /> Time l !/ Tlme <br /> THE LABORATORY MUST PROVIDE A COPY�F T S_CI IAIN CU_STO_D_Y WITH INVOICE ANl)RESULTS <br /> REV Ui163 � �� SltEl4 Oki COMPANY CItAIN OF CUSTODY <br />
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