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ARCHIVED REPORTS XR0003440
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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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 XR0003440
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Entry Properties
Last modified
6/24/2019 12:15:35 PM
Creation date
6/24/2019 11:11:04 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003440
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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S is Analytical <br /> esapeake Dr EXXON COM&Y, U.S.A. i <br /> Redwood Ctty CA 94063 P 0 Box 21813, Houstan,TX 77002-7425 <br /> (415)354 9600 • FAX (415)364-9233 CHAIN OF CUSTODY <br /> Consultant's Name oks Is L Page of <br /> Address 1(v`' old o,� --- - Slte Location k <br /> Project# Consultant Project# 1 Consultant Work Release # <br /> Project Contact J ` Phone # c (n (��o _ Laboratory Work Release # <br /> EXXON Contact C � �` , Phone # EXXON RAST <br /> # U <br /> Sampled by (print) J t tom, rn j L Sampler's Signature <br /> Shipment Method �W Air Bill # FL <br /> TAT ❑ 24 hr ❑ 48 hr ❑ 72 hr U1 96 hr Standard (10 day) ANALYSIS REQUIRED 1 <br /> Sample Collection Collection Matrix 40, Sequoia's TPH/Gas TPH/ TRpHw�a, remperature <br /> Prsv BTEX/ Diesel SM <br /> Date Ttme Sotl/VlaterlAlr <br /> Description Cont Sample# 8015/ EPA 5520 Inbound Seal Yes No <br /> � J Outbound Seal Yes No <br /> f/ 8020 8015 <br /> ell, o <br /> D <br /> ca0 <br /> Cr <br /> vim► C� 14d- <br /> q� L <br /> w — 1 c� h�-.lam- 11 �� <br /> RELINQUISHED BY/AFFILIATION Date Time ACCEPTED/AFFILIATION Date Time Additional Comments <br /> z. <br />
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