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ARCHIVED REPORTS XR0003472
Environmental Health - Public
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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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2575
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2900 - Site Mitigation Program
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PR0541989
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ARCHIVED REPORTS XR0003472
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Entry Properties
Last modified
6/21/2019 9:16:46 PM
Creation date
6/21/2019 3:34:18 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003472
RECORD_ID
PR0541989
PE
2950
FACILITY_ID
FA0024100
FACILITY_NAME
COUNTRY CLUB VALERO
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12302012
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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` BILL OF LADING <br /> 3909 Park Road, Suite D <br /> NVIRONMENTAL SERVICES Benicia, CA 94510 <br /> GROUP 1 (877) 748-3040 <br /> Western Region - <br /> DELIVERY DATE 1pgr x` <br /> 3HIPPER/CUSTOMER POINT OF CONTACT <br /> %DDRESS PHON # <br /> 't s' <br /> 11TY STATE ZIP <br /> BARRIER/TRANSPORTER PHONE# <br /> aONSIG►N1 EqE/FACILITY POINT OF CONTACT <br /> 4DDRESS - PHONE# <br /> CITY STATE ZIP <br /> Ok <br /> B <br /> D <br /> 3peciat Handling Instruction and Additional Information <br /> alacards Provided YES NO Emergency Phone#(877) 748-3040 <br /> SHIPPER S CERTIFICATION i hereby declared that the contents of this consignment are Sully and accurately described above by proper shipping name and are classc5ed packed <br /> marked,and labeled and are in all respects in proper condition for transport by hKghway,vessel,and rail according to appbcable international and national government regulations. <br /> (SHIPPER)PRINT OR TYPE NAME/ y ,x r _ - ;"(--SIGNATUIRE 1 1 MONTH DAY YEAR <br /> (CARRI>rW ANSPORTElR)PRINT OR TYPE NAME SiGNATLAW ~r r Morrr" DAY <br /> (CONSIGNEE/FACILITY)PRINT OI),TYPE NAME Y � SIGNATURE 01 N DAY YEM <br /> X ' f f <br /> worm#PSC-201-RV 6/04 <br /> FILE <br />
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