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ARCHIVED REPORTS XR0003461
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 XR0003461
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Entry Properties
Last modified
6/24/2019 12:22:04 PM
Creation date
6/24/2019 11:19:41 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003461
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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I <br /> IMON COMOWY, U.S.A. y112l� • SCS <br /> 1' 0 Rox 4415, Ilouslon, I X 77214-4415 <br /> INCOaPOapTEO CHAIN OF CUSTODY <br /> THE ASSURAXLE of auALM Novato, CA, 11 Dlgiial Drive, 949.19 ❑ Hunlington Beach, CA, 5702 Balsa Avenue, 92649 <br /> 415 883-6100 714 892-2565 <br /> Consultant's Name 06-1)x EFMU, coy-%S' C,r P4FL <br /> i <br /> Address "53 '1--100 MAW-1W C Vyz.440Vk CS. G"6'J 0 Site Location 2-7UE e0144 C1;ca Lj <br /> Pro eel b L40``• 0) Consultant Pro eft 11 Consultant Work Rt h ase N 6111 O 3 W i <br /> Project Contact k1111C.t Phone# °II(e 163� 70VT Fax a 371' WI Laborator Work Release Il <br /> EXXON Contact M�n-ti� 6)VLk%`S.1A—�© EE ElC&M Phony N $�U 2�P - t'7'111 Fax.# EXXON RAS N -7— 3�0� <br /> Sam led h ( nnl (►r✓M' H34Z Sam Ii.r•s SE nature, <i..1(,[�..— —zF1 <br /> Shipment Mt.ihoJ oGe Air Bill N Shi nwnt Date. �• Z <br /> TAT ❑ 24 hr ❑ 48 hr ❑ 72 hr D< Standard (S day) ANALYSIS REQUIRED S4111111L Cuntlitiun .is R«1.IvLd <br /> T,-mpuatur1," C <br /> Cuulcr # <br /> a Inbound Sk'al 1'Ls leo <br /> W <br /> 00 �, Outbound Seal 1�5 lV,i <br /> Sample Descnplion Collection Melnx Prsv #of PACE v Cc A 0000 a <br /> Date/Time Sod/Water Cont Semple YQ Q Q <br /> � W1- F-- COMMENTS <br /> a. W E- W <br /> 3 awgbi4 x <br /> AAs. <br /> mw • � w 3 4z.�- � <br /> w 03 3 Wr <br /> Mw (o 0 3 44. <br /> w •3 112 W *3 �k5tI X <br /> i <br /> loll <br /> Relinquished bylAffiliauon Dale Time Accepted bylAf4ilation Dale Time Additional C011MIL S <br /> DiNtnhution While-Original Yelinw- Exxon Ptnl. L Goldenrod Consullant Field Staff <br />
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