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ARCHIVED REPORTS XR0003741
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 XR0003741
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Entry Properties
Last modified
6/21/2019 9:04:10 PM
Creation date
6/21/2019 4:37:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003741
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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SMELL OIL COMPANY CHAIN OF CUSTODY RECORD Date: <br /> RETAIL ENVIRONMENTAL, ENGINEERING - WEST Serial No.� �88'TZR-S1 _ page 3 of 3 <br /> Site Address: <br /> 2575 County Club Blvd. , Stockton, CA Analysts Required LAB: �fcTotAl <br /> iC �•... CHECK ONE(1)lox ONLY CT/Dl TURN AROUND TIME <br /> 204--7524-3505 Uw a ii <br /> Shell Engineer: Phone No.: 510 G W Monlorine C] "&1 7t noun� �I Cl <br /> 7 616$ srornv.dlyalron 4"1 <br /> Alex Perez Fa i; - t 4E II ainaun El <br /> Conl� I qnl N m & dd ess• sol Claulry/ukporar ❑ "42 <br /> Maine 'tech 5ery ces, Inc. .�. 16 days ❑(Hormaq <br /> 1680 Rogers Ave San Jose CA 95112 X Wa1•r u43 <br /> w Q Clwery/Dirporal ❑ 01h.r ❑ <br /> Cansuilanl Contact. >'hone Na,; 408- N N1311 11 <br /> o:µR rnofSp ❑ us: <br /> Fran Thxe 573-0555 <br /> Fax N 573-7771 a (D a L NOTE Nollrylabas <br /> Comments; 4 _ Wolof Rom.or S boon cis►oarlbl•of <br /> V 0+M ❑ 4JS3 24/48 his TAT <br /> v ro o <br /> co TIN <br /> Cn Z 01har ❑ <br /> Sampled by. "' 'n o d o c �; } w <br /> in m a o o N D N US7 ArGENCY: U']ck ?? ItYB J'; <br /> Printed Name- UGr SAjvD,:-s 0- W tu 0 a v 0 MIATERIAL SAMPLE <br /> Sample ID Dole Sludge Boll Water Alf No of q � o o X o m o DESCRIKION CONDITION/ <br /> cones r_ m > U U COMMENTS <br /> cq r->yzi►i s zi1 � G II -__� x x <br /> ZNsz 17- <br /> If x II <br /> 2y5y cc x II x X <br /> ZY ,L cc- x — — x x <br /> II <br /> l zc��8 cam, II X x — <br /> I� II <br /> Reim shod gnature), ad me jDate T&y RaceNod(slgnaluro), PtInfed Name, Dale 9' <br /> RelingWsh d By(signal ). Ptlnled Name. Dale 0 Recolvad (seg alum}, �� Pr need Namo�i Da e <br /> t/ C /S yr plc ci Time, Time. <br /> alingufshod B (slgnaluro): Ptlnled Name. Data ReceNad (signalura Printed Name. Dare <br /> Time7— o C)"J,1'jS mo. 12 <br /> THE LABORATQRY MUST PlLQY1QU5,'Ql!Y QA]61N-QF-CU51QQ,y fflffl IUMOICE AND RESU S H <br />
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