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ARCHIVED REPORTS XR0003336
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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2705
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3500 - Local Oversight Program
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PR0544595
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ARCHIVED REPORTS XR0003336
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Entry Properties
Last modified
6/24/2019 12:24:17 PM
Creation date
6/24/2019 10:10:08 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003336
RECORD_ID
PR0544595
PE
3528
FACILITY_ID
FA0002048
FACILITY_NAME
TESORO (Shell) 68221(WRR 6290)
STREET_NUMBER
2705
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12121008
CURRENT_STATUS
02
SITE_LOCATION
2705 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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• Chain of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento E] Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#14117 <br /> Rancho Cordova,CA Location 2725 Country Club Blvd <br /> Stockton, California <br /> Project# 77EL 14117 43 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory Kiff AnalyticalC4 _ <br /> GO <br /> W12 <br /> Turnaround Time Standard aa x �, <br /> UJ n U n <br /> �? > o Y <br /> Sampler's Name Danielle Catlin-Wright w „ m a <br /> = o „ o 0 <br /> Sampler's Signature °.. a ro o N o N a W <br /> ° _ ; = o a g � 'Q =° E � x a 2 a Comments/ E <br /> Sample ID Date Time Matnx z a m a` C (0z � co ° w w Instructions z <br /> L-1 -- 5` 04/21/03 1 'Sq Soil X X X 1 <br /> L - 19 2.21 X X X 1 <br /> Sig" 2 41 X -X X r <br /> 51' 3 .09 <br /> Special Instructions/Comments Relinquished by Received by Sample Receipt <br /> 5 Oxygenates TAME, MtBE, EtBE,TBA, & DIPE Sign ign Total no of containers <br /> email results to rauchterloniefsecor corn Print rLaliwV- Pnnt Chain of custody seals <br /> CompaCompany Recd in good condition/cold <br /> Time Date__&cj__ o3 Time Date Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client SECOR <br /> Print Print Client Contact Jaff Auchterlonie <br /> Company Company K,+ _Art u-h Cal� Client Phone (916)861-0430 <br /> Time Date Time Date ay O3 ext 241 <br /> SECOR CUSTREC PW 2199 <br /> Date Page <br />
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