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ARCHIVED REPORTS XR0003443
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 XR0003443
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Entry Properties
Last modified
6/24/2019 12:21:43 PM
Creation date
6/24/2019 11:13:59 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003443
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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r�� u"Nnatyucal ' EXXON CORNYf U.S.A. <br /> r/e�I"'. Chesapeake Dr <br /> JW Redwood City,CA 94063 p 0 Box 2180,Houston,TX 77002-7426 <br /> (415)364-9600 • FAX(415)364-8233 CHAIN OF CUSTODY <br /> Consultant's Name- Page of <br /> Address: Site Location Ac/ <br /> Project#: Consultant Project#. r Consultant Work Release#.•�� � <br /> Project Contact• Phone#. 8j8r— Laboratory Work Release#: <br /> c <br /> EXXON Contact:/& e— Phone# EXXON RAS# <br /> U <br /> Sampled by(print): a4e3� Sampler's Signature• <br /> c <br /> Shipment Method. Air Bill #• a <br /> TAT. ❑ 24 hr ❑48 hr 72 hr ❑ 96 hr tandard (10 day) ANALYSIS REQUIRED <br /> Sample Collection Collection Matrix # of Sequoia's TPFIGas TPF/ TRPH Temperature <br /> Description Date Time SollMaterlAir Prsv Cont Sample# BTEXI Diesel <br /> 8015/ EPA 5520 Inbound Seal Yes No <br /> 8020 8015 Outbound Seal Yes No <br /> 0 <br /> �r� 1 Q <br /> ga3 I <br /> -3 �- <br /> _ 4 <br /> .� rr <br /> 0 <br /> -� M <br /> L <br /> i <br /> R5pqUISHED BY/AFFILIATION Date Time CCEPTED/AFFILIATION Date 'Time Additional Comments <br /> _ 'Q )a q0 <br />
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