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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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LOUISE
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1196
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3500 - Local Oversight Program
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PR0545438
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Last modified
3/9/2020 2:51:53 PM
Creation date
3/9/2020 1:17:07 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545438
PE
3528
FACILITY_ID
FA0000848
FACILITY_NAME
QUIK STOP MARKET #2121
STREET_NUMBER
1196
Direction
W
STREET_NAME
LOUISE
STREET_TYPE
AVE
City
MANTECA
Zip
95336
APN
217-410-43
CURRENT_STATUS
02
SITE_LOCATION
1196 W LOUISE AVE
P_LOCATION
04
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 REPO <br /> Date: - u - CONSTRUCTION <br /> Premise Address: (Q (f '� Total Depth 1-5 <br /> ,/y� Screen Length (from) 7 (to) S <br /> Well No.: / ► 1 IA) -q Filter Pack (from) -7 S (to) bz� <br /> Bentonite (from) (D 3 (to) (0 f <br /> Inspector: 240470 vV) Grout (from) ts I (to) . <br /> Drilling rig e <br /> Permit No. > G/ �-3 _ Auger O.D. W I.D. <br /> / Completion - Stove pipe/clu-istie box (circle one) <br /> Drilling Company:. (;- 'C <br /> Driller: �'>�rtS � /�1yt r �— casing <br /> height <br /> Consultant IV <br /> Geologist u <br /> ABOVE-GACUND CHAIM43OX <br /> COMPLE CN COMPLEnON <br /> SPECIAL PERMIT INFO. Ground Surfacs ��� <br /> grout <br /> Distance to sewer line <br /> Domestic well on site - (y/n) ft. <br /> If yes, location and distance - ft. <br /> ft. <br /> SAMPLING <br /> tlot•.ai <br /> socion — <br /> Holding Temperature <br /> Method zv. — V2VW Pads <br /> Screening Method <br /> Tracking Sheet - (y/ n) <br /> ft. <br /> SPOILS (� <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - (y <br /> Storage Location 1,6j'Act S'D lam— Casing type <br /> Blank LoS ft. Screen <br /> Slot size . ba f� <br /> GROU'T'ING Bags cement <br /> Buckets bentonite _ 4 <br /> Depth to water M Bags sand/gravel <br /> Mix Ratios Filter Pack type/size P <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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