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COMPLIANCE INFO_2006-2011
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_2006-2011
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Last modified
2/22/2023 1:52:51 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
2006-2011
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_2006-2011.tif
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EHD - Public
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■ Complete items., AI e <br />item 4 if Restrict Fk <br />s <br />■ Print your name n ado h re rse <br />so that we can°'retu td y <br />■ Attach this card to theo e, <br />or onthe front if space permits. <br />1. Article Addressed to: <br />MIKE AHMADI <br />MARIE JORDON <br />DAVE HINDS <br />587 YGNACIO VALLEY RD <br />WALNUT CREEK CA 94596-3801 <br />RE:: 2575 COUNTRY CLUB RTN: GB <br />I 2. Article Number <br />(Transfer from service label) <br />IPS Form 3811, February 2004 <br />A. Signature <br />7008 1830 0004 8693 7907 <br />Domestic Return Receipt <br />102595-02-M-1540 <br />❑ Agent <br />Addressee <br />B P= <br />Date of Delive <br />/Rye�c <br />D. Is delivery address different from Rem 1? ❑ Yes <br />If YES, enterdelivg�y We low: <br />FR <br />❑ No <br />ENVIRONMENT HEKTH <br />PERMIT/SE"ES- <br />3. Service Type <br />*g Certified Mail ❑ Express Mail <br />❑ Registered ❑ Return Receipt for Merchandise <br />❑ Insured Mail ❑ C.O.D. <br />4. Restricted Delivery? (Extra Fee) <br />❑ Yes <br />7008 1830 0004 8693 7907 <br />Domestic Return Receipt <br />102595-02-M-1540 <br />
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