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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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a 0 116V1 4 11 / HSI 1 Hg <br /> 4 <br /> SHELL OIL COMPANY CHAIN OF CUSTODY RECORD Dale: <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Sorial No 70 vIzq-S i _ page Z of 3 <br /> Silo Address; 5rE Qoo�� <br /> ''!�+ 2575 Country Club Blvd. , Stockton, CA Analysis Required LAR: <br /> ICI: 204-7524-3505 �j CHECK ONE(1)AOX ONLY CVDr I TURN AROUND TIME <br /> 1 C W monloriny ❑ 4141 <br /> Shell Engineer. Phone No.: 510 0 24houn ❑ <br /> Alex Perez FdW-6168 + 3116lnvoillpdbn ❑ 4U175-6172 48 hours ❑ <br /> CoVIcTI N�m�&�4ddress. 0 0 Sol Clo"lly/plsposol ❑ 4u2 <br /> a ne eC erVices, Inc. a� � 15days ❑(Normal) <br /> 1680 Rogers Ave, San Jose CA 95112 x wofor <br /> Col15Ullarll Contact: o all Classlry/Dloposal ❑ 4w Olhrrr ❑ <br /> Phone No.; 408- = v m <br /> Q1 N Sol[/Air Rom or Sys <br /> Fran Thie 573-0555 OAM ❑ usx <br /> Fdx 573-7771 .n O Nor[ Noluytoaar <br /> U 0 Q Wolor Aran,ar Sys soon as Pa.rlble or 1 <br /> Comments: d chi a i M ❑ ase 24141 his [AT <br /> CD <br /> O O N x <br /> U nZ olh•r El <br /> Sampled by-.S. ',n C4 o a r <br /> 0 0 t 0. 0 n L- LIST AGENCY: <br /> U <br /> Prinled Name; POLIO- 5AVVVJ4 L L � ° a o SAMPLE <br /> `" _ -- N o d o. MATERIAL <br /> No or x x k N .A a Co. E CONDITION/ <br /> Sample 1D Delo Sludge Sop Wales Air cones Co. m � U ¢ 0 U DESCRIPTION COMMENTS <br /> 9z ft-cao r X & X <br />�I ImL'i- 11 x x X <br /> z Mw-1Z. G x y <br /> Aws- I A - x <br /> 7 G - xx <br /> >tel stlod (signature). Prinl�a0�a� X35 Da)v Racalvv gnalury Prinlvd �. Data <br /> J limo X07 "� ► O <br /> Wlnqu Prinlod Homo. Dole Rocolved (slgnaluro), Printed Name: Date, <br /> Time mo <br /> lzellnquis ad By(slgnahrre). Prinled Name. Duo iZec 1Inly l�qm� pale ?a � <br /> o TIT TlmTIma 2;2 <br /> lmw clan of cu-w <br />
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