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COMPLIANCE INFO_2004-2005
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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2300 - Underground Storage Tank Program
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PR0231070
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COMPLIANCE INFO_2004-2005
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Last modified
1/30/2023 2:30:02 PM
Creation date
6/3/2020 9:43:34 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2004-2005
RECORD_ID
PR0231070
PE
2351
FACILITY_ID
FA0006439
FACILITY_NAME
COUNTRY CLUB MOBIL CIRCLE K
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\UST\UST_2351_PR0231070_2575 COUNTRY CLUB_2004-2005.tif
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EHD - Public
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BILL OF LADING <br /> 3909 Park Road,Suite D <br /> N RONMENTAL SERVICES Benicia, CA 94510 <br /> GROUP (877) 748-3040 '.,iai V ,� _ . sn f e <br /> Western Region <br /> DEUVERY DATE JOB# <br /> ;HIPPER/CUSTOMER POINT OF CONTACT <br /> DDRESS PHONE# <br /> .-sr_ t`a.i +{W C4 m' <br /> ,rTY,STATE,ZIP- <br /> CIA 54S904 <br /> ;ARRIER/TRANSPORTER PHONE# <br /> ' <br /> ,ONSIGNEE/FACIUTY POINT OF CONTACT <br /> wsrRe ° <br /> ADDRESS PHONE# <br /> '•3',#`a cr9..TS"I load <br /> :ITY,STATE,ZIP A y <br /> b( C�7xh tl ifs YA!r`17 nlul? 1sml! Min , v <br /> ! l� <br /> 3 <br /> pecial Handling Instruction and Additional Information: <br /> `$�- �MMUS 1UIN b901zrD IR-A'f+uAs-: . �FAIR Yvon <br /> 2 (03) SO-MI ('1751 F39 Ag AC(:�'s'MMF 1;49ti5 <br /> 'lacards Provided YES NO Emergency Phone#(877) 748-$040 <br /> :RIPPER'S CERTIFICATION:i hereby declared that the contents of this consignment are fully and accurately described above by proper shipping name and are classified,packed, <br /> larked,and labeled,and are in all respects in proper condition for transport by highway,vessel,and rail according to applicable intestional and national government regulations. <br /> SHIPPER)PRINT OR TYPE NAME / SIGNATURE MONTH DAY vEaa <br /> CARRIER/TRANSPORTER)PRINT OR TYPE NAME SIGNATURE MONTH DAY YEAR <br /> C X <br /> CONSIGNEE/FACKJITY)PRINT OR TYPE NAME SIGNATURE :v MONTH-1 DAY JWM <br /> f` + <br /> X <br /> orm#PSG-201-RV 6/04 <br /> SHIPPER <br />
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