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FIELD DOCUMENTS
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HAZELTON
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2025
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2900 - Site Mitigation Program
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PR0505804
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Last modified
1/31/2020 6:06:16 PM
Creation date
1/31/2020 3:51:33 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0505804
PE
2960
FACILITY_ID
FA0007013
FACILITY_NAME
KOPPEL STOCKTON TERMINAL
STREET_NUMBER
2025
Direction
W
STREET_NAME
HAZELTON
STREET_TYPE
AVE
City
STOCKTON
Zip
95203
CURRENT_STATUS
01
SITE_LOCATION
2025 W HAZELTON AVE
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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WONITORING WELL INSTALLAMON REP# <br /> Date: /0 - / GV�dJn CONSTRUCTION �J <br /> Premise Address: 61%— 2025 W (X 'e- Total Depth <br /> / Screen Length (from) (to) <br /> Well No.: 4110 16S'e' Filter Pack (from) (to) 2 <br /> Bentonite (from) 512— (to) <br /> Inspector: Grout (from) <br /> '/ Drilling rig type <br /> Permit No. �QLT Auger O.D. I.D. <br /> Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: <br /> Driller: sy—et v casing <br /> height <br /> Consultant <br /> Geologist ABOVE-GRCUND <br /> COMPLETION COMPLY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surf'°' <br /> Distance to sewer line �� <br /> 75 r grout <br /> Domestic well on site - (Y 4D - ft. <br /> If yes, location and distance - ft, <br /> 78 <br /> = e <br /> = e <br /> SAMPLING slotted = t-' <br /> sec5on <br /> Holding Temperature = gravel pack <br /> Method <br /> Screening Method = r <br /> Tracking Sheet - (y/ n ) <br /> It. <br /> SPOILS ``�� /n ��Q� <br /> Storage Method �� '5 +t — MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) I 1 Lir` VC <br /> Storage Location Ya ` 2�L5y l a Casing type !! I <br /> Blank b �_ft. Screen 6 ft. <br /> Slot size <br /> GROUTING Bags cement 7 <br /> _ Buckets bentonite So' <br /> Depth to water �J r Bags sand/gravel <br /> Mix Ratios I Filter Pack type/Ste <br /> e <br /> Installation Method Surge Block: - (�n ) <br /> Quantity Installed Discussed with geologist: - i,y n ) <br /> Type of method 1 <br /> EH 29 29 <br />
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