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FIELD DOCUMENTS FILE 3
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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3500 - Local Oversight Program
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PR0544595
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FIELD DOCUMENTS FILE 3
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Last modified
6/24/2019 10:55:26 AM
Creation date
6/24/2019 10:01:20 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 3
RECORD_ID
PR0544595
PE
3528
FACILITY_ID
FA0002048
FACILITY_NAME
TESORO (Shell) 68221(WRR 6290)
STREET_NUMBER
2705
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12121008
CURRENT_STATUS
02
SITE_LOCATION
2705 COUNTRY CLUB BLVD
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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1 <br /> MONITORING WELL INSTALLATION REP it f <br /> Date: J CONSTRUCTION <br /> Premise Address: Z�oS (.D Total Depth 30 <br /> Screen Length (from) 50 (to) <br /> Well No.: '� Filter Pack (from) 3o (to) <br /> Bentonite (from) 1��(to) 11 <br /> Inspector. Grout (from) I t (to) <br /> ! 3 Drilling rig type <br /> Permit No. Auger O.D. V N2 I.D. $ <br /> Drilling Company: <br /> Completion-Stove pipe/christie boa (circle one) <br /> f��/ <br /> Driller._ Nw&4-te. �'" �!/1«- '�" casing <br /> �� height &tm <br /> ConsultantI T <br /> Geologist 7-11r;ABOVE-GROUNDC <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surface <br /> Distance to sewer line L 5-O gro(A <br /> Domestic well on site - (y n <br /> If yes, location and distance- ,I•� n' <br /> ft. <br /> w = <br /> SAMPLING slotted ^ � c <br /> i, <br /> Holding Temperature40 <br /> scn 4 <br /> Method = P <br /> adc <br /> Screening Method = '_ <br /> Tracking Sheet <br /> I4 <br /> SPOILS <br /> Storage Method MATERIAI&DEVELOPMENT <br /> Contamination Noted - ( / ) I I PVC0 Storage LocationA Casing type <br /> Blank ft. Screen L5 ft. <br /> Slot size •0 <br /> GROUTING Bags cement <br /> Buckets bentonite_ <br /> Depth to water r 110 Bags sand/gravel _ <br /> Mia Ratios Filter Pack typesize <br /> Installation Method 4 Surge Block: - (y n <br /> Quantity Installed _ Discussed with geo ogist: - (Y AD <br /> Type of method <br /> EH 29 29 <br />
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