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ARCHIVED REPORTS XR0003748
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 XR0003748
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Entry Properties
Last modified
6/21/2019 9:40:51 PM
Creation date
6/21/2019 4:41:17 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0003748
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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SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dale: <br /> RETAIL. ENVIRONMENTAL ENGINEERING - WEST Serial No. g001 Zg-s I Page I or 3 <br /> Silo Address: S,�QVoi <br /> Analysis Required LAB: <br /> 'r1 2575_ Country Club Blvd. , Stockton, CA <br /> w ICI: CHEC%ONE(1)iOX ONLY CT/01 TURN AROUND IME <br /> 204-7524-3505 <br /> Shell Engineer. Phone No.: 510 G.W. IAoellork+y ❑ 4+i1 24 hours ❑ <br /> — ---'-- 7 —6168 ire Ihvs�llpdbn ❑ t4i1 ' <br /> Alex Perez Fa� . t A#hours ❑ <br /> Con �lc�nl N�m�&SAddsess: � }�,^ SolCkmIty/Dlspaol ❑ 41i7 <br /> a ne ec ervices. Inc. g ladays ❑(f+ormon <br /> 1680 Rogers Ave. San Jose CA 9511.2 w Water �k oaf Cl 443 <br /> Consullanl Conlacl: Phone No.; 408- = m •I' `� Other ❑ <br /> 573-0555 " " ago /Air M Rem or Sys ❑ Ms; <br /> Fran Th1e o� Ol <br /> Fax N. 573-7771 0 �' d Ul 4 <br /> CI- Hort uefuyiobo, <br /> C.flmmenls• Q <br /> 13 .� N soon at Possible of <br /> s`: O a<bA ❑ 4<S] 2I/45 his TAT _ <br /> U Z Dlhe� ❑ <br /> Sampled by: o v o N }� � <br /> 0 C3a o o UST AGl~N 1 <br /> Prinled Name: Poth SA ill D ewzf a 2 w m o c "o <br /> ° o o °- MATERIAL SAMPLE <br /> No of s s U A o h -Q Q DESCRIPTION CONDITION/ <br /> Sample ID Dato Sludge soft water Ali canis o y U 4 (j a u �� COMMENTS <br /> 7 Mw-g ).F x <br /> 8 Mw—q 1p X X <br /> Ropn shod (s!gnaluro). Prinled Name. DO Roca (stg lura Prinled�srrrro. Dalo <br /> pov&- SAA/DQtS Time/ II U �T <br /> Ro(Inqul y na Prinled Name. �� Dafo Roc lved (sJgnaluro). Prinlod Name. II Dole, <br /> Timef lE Il 11me <br /> Rollnqul hod by(slpnakme) P W Nomu Dolo 91 Rocoly lu Prinlod,?jR�t. ul Dole 30111 <br /> ' limo ]I ✓ II Tlma .Z6 <br /> II <br /> �r a .rwbw <br />
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