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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 Da10: <br /> RETAIL ENVIRONMENTAL ENGINEERING - WEST Sona! No.__._. o I29 -5 I Pago 3 of.5 <br /> Silo Address: <br /> ��l 2575 CountryClub Blvd. , SLOckton, CA Analysis Required LAB: Wowo1A <br /> w tCli: <br /> 201-752+-3505 CIIECK ONE(1)sOX QNCY CT/DT TUAN AROUND 11111E <br /> * <br /> GW Monloriny ❑ 4111 24 hour <br /> Shell Engineer: Phono No.: 5101 £ ❑ <br /> (]5 �16$ St•Inv1l3parbn 4ul ❑ <br /> Alex Perez Fa�C # � � ❑ 41 hour <br /> Conj�lcnf Ng%&�4ddress• 0 36RC1osslry/Dl.polal ❑ 444z <br /> ane ec ervices, Inc. 8 H day& ❑wo+mon <br /> 1680 Rogers Ave. San Jose CA 95112 x Wofor <br /> 1-1, Clwsi[/011 sal ❑ �� <br /> p Y Ao O1h•r ❑ <br /> Cansullant Corllacl: Phana No:, 408- <br /> 573-0555 �' `„ co soir/AkA•morSys 4452 <br /> Fran Thie Pax o m `a °� °+M ❑ <br /> 573--7771 NOTE N•rlryLabus <br /> Comments: a -- Ov Wet R•rm or Sys 1064W?*.Nib$•or <br /> TJ cv 1v1 O a M ❑ 44S7 ]4/411 h11 lAf <br /> U n Olh•r ❑ <br /> Sampled by. �' <br /> UST AGENCY: <br /> �1J� SA S <br /> Printed Name• d O n b �' <br /> NU6�Z � � ,r; n, C. 2 c o SAMPLE: <br /> No or 1 1x x s c C4 E MATERIAL CONDITION/ <br /> Sar>Etp�e 1D Daio 5tudpa 5011 Water Air cents ,�! U O ¢ U a U DESCRIPTIO" COMMENTS <br /> Franco x � j� - x <br /> �vsci•er X C, �� �— x X - <br /> w --PC"i x fx (e )< x — <br /> RaII shad By nafura). Priniad Name. Date /,, eca (slg slur PIIn1ad DOIo <br /> �- Nr Time D,1/0 " <br /> i(allnquE B slq ay. Nin ad Name. Dala Roc od(slgnalu a} Prinl d Name. Du e <br /> lima 1E limo " <br /> Rolla shod By(slpnaturo) Pfinled Name Data 1E Roca Minlod Na Dale 14 <br /> tlrrro 1C 2_ <br /> II <br />
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