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FIELD DOCUMENTS CASE 2
EnvironmentalHealth
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BELLA LAGO
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2900 - Site Mitigation Program
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PR0523856
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FIELD DOCUMENTS CASE 2
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Last modified
9/16/2019 3:17:40 PM
Creation date
9/16/2019 3:08:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
FileName_PostFix
CASE 2
RECORD_ID
PR0523856
PE
2965
FACILITY_ID
FA0016065
FACILITY_NAME
OAKWOOD SHORES
STREET_NUMBER
1699
STREET_NAME
BELLA LAGO
STREET_TYPE
WAY
City
MANTECA
Zip
95337
APN
24152013
CURRENT_STATUS
01
SITE_LOCATION
1699 BELLA LAGO WAY
P_LOCATION
99
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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MONITORING WELL INSTALLATION REPORT <br /> Date: j/ ull3, Iql y7 CONSTRUCTION <br /> Premise Address: Total Depth <br /> Screen Length (from) (to) <br /> Well No.: Filter Pack (from) (to) <br /> Bentonite (from) (to) <br /> Inspector: Grout (from) (to) <br /> Drilling rig type <br /> Permit No. Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: casing <br /> height <br /> Consultant <br /> Geologist <br /> ABOVE-GROUND <br /> COWFLEfION CHRtm-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground gur(acs <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) ft <br /> If yes, location and distance - <br /> ft. <br /> ft. <br /> C <br /> SAMPLING = <br /> section — <br /> Holding Temperature <br /> Method _— 71W Pack <br /> Screening Method — <br /> Tracking Sheet - (y/n) <br /> •:kms _ <br /> y .a� <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) <br /> Storage Location Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios Filter Pack type/size <br /> Installation Method Surge Block: - ( y/ n ) <br /> Quantity Installed Discussed with geologist: - (y/ n ) <br /> Type of method <br /> EH 29 29 <br />
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