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ARCHIVED REPORTS_XR0009193
EnvironmentalHealth
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3500 - Local Oversight Program
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PR0545651
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ARCHIVED REPORTS_XR0009193
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Last modified
5/6/2020 11:47:28 AM
Creation date
5/6/2020 11:25:07 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0009193
RECORD_ID
PR0545651
PE
3528
FACILITY_ID
FA0002479
FACILITY_NAME
7-ELEVEN INC #17334
STREET_NUMBER
4501
Direction
N
STREET_NAME
PERSHING
STREET_TYPE
AVE
City
STOCKTON
Zip
95207
APN
11017004
CURRENT_STATUS
02
SITE_LOCATION
4501 N PERSHING AVE
P_LOCATION
01
P_DISTRICT
002
QC Status
Approved
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EHD - Public
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SECOR Inkmational Ina <br /> WATER SAMPLE FIELD DATA SHEET <br /> *OJECT# 7-Eleven Store 417334 PURGED BY Peng Vang _ _ WELL I D MW- 3 <br /> CLIENT NAME 7-Eleven,Inc SAMPLED BY Peng Vang SAMPLE I B MW- 3 <br /> LOCATION 4501 North Pershing Avenue,Stockton,CA QA SAMPLES None <br /> DATE PURGED START(2400hr) END(2400hr) U 9 <br /> DATE SAMPLED _ -Z j-o S SAMPLE TIME(2400hr) ) 1 fl <br /> SAMPLE TYPE Groundwater X Surface Water Treatment Effluent Other <br /> CASING DIAMETER 2" X 3" 4" 5" 6" 8" Other <br /> Casing Volume (gallons per foot) (0 17) (0 38) (0 67) (I 02) (1 50) (2 60) ( ) <br /> DEPTH TO BOTTOM(feet)_ -3'� 3:z CASING VOLUME(gal)= 2 <br /> DEPTH TO WATER(feet)= j 7, CALCULATED PURGE(gal) <br /> WATER COLUMN HEIGHT(feet)_ _ / ,(,g ACTUAL PURGE(gal)= <br /> = FIELD MEASUREMENTS <br /> t <br /> DATE TIME VOLUME TEMP CONDUCTIVITY pH COLOR TURBIDITY <br /> (2400hr) (gal) (degrees C) (umhos/cm) (units) (visual) (NTU) <br /> zl •� 'fSy lf,Bre <br /> SAMPLE INFORMATION <br /> SAMPLE DEPTH TO WATER SAMPLE TURBIDITY ,�J <br /> 80%RECHARGE C YES NO ANALYSES BTEX,TPHg,5 Oxygenates Via EPA 8260B <br /> ODOR tk= SAMPLE VESSEL/PRESERVATIVE HCL <br /> PURGING EQUIPMENT SAMPLING EQUIPMENT <br /> Bladder Pump Bailer(Teflon) Bladder Pump Bailer(Teflon) <br /> Centrifugal Pump Bailer(PVC) Centrifugal Pump X Batter ( PVC or X disposable) <br /> X Submersible Pump Bailer(Stainless Steel) Submersible Pump Bailer(Stainless Steel) <br /> Penstalw Pump Dedicated Penstalic Pump Dedicated <br /> Other Other <br /> Pump Depth <br /> WELL INTEGRITY LOCK# <br /> REMARKS b <br /> SIGNATURE <br /> Page of 5 <br />
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