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FIELD DOCUMENTS_FILE 2
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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HARLAN
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15600
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3500 - Local Oversight Program
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PR0545273
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FIELD DOCUMENTS_FILE 2
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Last modified
2/3/2020 11:58:01 AM
Creation date
2/3/2020 11:00:57 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 2
RECORD_ID
PR0545273
PE
3528
FACILITY_ID
FA0000174
FACILITY_NAME
JOES TRAVEL PLAZA
STREET_NUMBER
15600
Direction
S
STREET_NAME
HARLAN
STREET_TYPE
RD
City
LATHROP
Zip
95330
APN
19620079
CURRENT_STATUS
02
SITE_LOCATION
15600 S HARLAN RD
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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MONITORING WELL INSTALLATION RE'PLl'RT <br /> Date: 3 Ia [ b CONSTRUCTION <br /> Premise Address: 15-5 Lf U l't `— Total Depth �1 I <br /> I <br /> �� Screen Length (from) 1 (to) <br /> Well No.: Filter Pack (from) V7 (to) <br /> Bentonite (from) ;�-S (to) 3 <br /> Inspector. fvr ¢� -coo r<� Grout (from) 2 9' <br /> f I0 Drilling rig type h <br /> Permit No. LAI `{ Auger O.D. �1 I.D. <br /> r� Completion - Stove pipe/christie box (circle one) <br /> Drilling Company: `� � ` � � t�1 ��� <br /> Driller: casing <br /> height <br /> Consultant ��o .,.. <br /> Geologist 1 -e k'V <br /> ABOVEGROUND CNAlST1 80X <br /> COt.�LJ:TION COMPLETION <br /> SPECIAL PERMIT INFO. Ground Surfxw <br /> Distance to sewer line grout <br /> Domestic well on site - (y/n) <br /> ft. <br /> If yes, location and distance - <br /> e <br /> m <br /> +� O <br /> C <br /> O <br /> SAMPLING SIOttBd = B <br /> sacdon — <br /> Holding Temperature _ grSW Pack <br /> Method <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> 37 ftIF <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y/ n ) << <br /> Storage Location Casing type <br /> Blank ft. Screen <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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