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COMPLIANCE INFO_1995-2004
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0231070
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COMPLIANCE INFO_1995-2004
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Last modified
1/30/2023 2:09:10 PM
Creation date
6/3/2020 9:43:33 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
1995-2004
RECORD_ID
PR0231070
PE
2351
FACILITY_ID
FA0006439
FACILITY_NAME
COUNTRY CLUB MOBIL CIRCLE K
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2351_PR0231070_2575 COUNTRY CLUB_1995-2004.tif
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EHD - Public
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0 SECTION I <br />NOTIFICATION <br />�i 05 <br />;q9 - <br />BUSINESS NAME Country Club Shell=NVIRnNMFNTA! <br />PERMIT/SERVICES <br />FACILITY STREET ADDRESS 2575 Country Club <br />CITY Stockton ZIP 95204 <br />FACILITY TELEPHONE 209-948-0574 <br />MAILING ADDRESS Shell Oil Company, P.O. Box 4023 <br />CITY Concord, CA ZIP 94524 <br />TELEPHONE 510-675-6100 <br />(If different from company headquarters) <br />LOCAL PRIMARY BUSINESS EMERGENCY CONTACT <br />NAME Steve Griffen <br />RESIDENCE 3002 Monticello Dr., Stockton 95209 <br />TELEPHONE (OFFICE) 209-948-0574 (HOME) 209-957-5461 <br />LOCAL ALTERNATE BUSINESS EMERGENCY CONTACT <br />NAME Craig Furgison <br />RESIDENCE 3453 North Star St., Stockton 95209 <br />TELEPHONE (OFFICE) 209-943-3633 (HOME) 209-951-0149 <br />24-HOUR ON-SITE CONTACT Steve Griffen TELEPHONE 209-948-0574 <br />(If Available) <br />I declare under penalty of perjury that I have reviewed this entire Hazardous Materials Man- <br />agement Plan and it is accurate to the best of my knowledge. I understand that false/inaccu- <br />rate information may contribute to complications during a hazardous materials incident. This <br />declaration is made in the city of Stockton , California. <br />NAME OF ON-SITE MANAGER /` <br />SIGNATURE OF ON-SITE MANAGER <br />NAME OF PERSON Robert H. Lee & Associates - Steven A <br />Responsible for the completion of HMMP (PRINT) <br />TITLE <br />DATE'*y 7 <br />TITLE Project Manager <br />SIGNATURE � DATE �'� <br />
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