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3500 - Local Oversight Program
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PR0545776
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Last modified
5/28/2020 4:43:22 PM
Creation date
5/28/2020 4:35:00 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0545776
PE
3528
FACILITY_ID
FA0002231
FACILITY_NAME
JACK FROST ICE SERVICE
STREET_NUMBER
425
Direction
N
STREET_NAME
UNION
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
15112003
CURRENT_STATUS
02
SITE_LOCATION
425 N UNION ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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4 <br /> �ONITORiNG WELL INSTALLATION REPCs� <br /> Date: �C-' CONSTRUCTION .. <br /> Premise Address:_-- �l�'J VI�LC _ Total Depth <br /> Screen Length (from)_ fQ O (to) <br /> Well No.: . Filter Pack (from) (to) <br /> Bentonite (from) (to) S5 <br /> Inspector: �"CL�iH1 ' Grout (from) (to)_ 6Z <br /> Drilling rig type <br /> Permit No, t Auger O.D. I.D.: <br /> Completion - Stove pipe/christie box (circle one) ; <br /> Drilling Company: <br /> Driller: L±bLS Gh.r" C'Cv, 7asinq <br /> _ height � <br /> Consultant V1t_�T_ .- <br /> 7/4 <br /> Geologist WO SWLI�h <br /> ABOVE-GRCUND C�-WISrY�OX <br /> co �to�t CAOMPLEncH <br /> SPECIAL PERMIT INFO. Ground Suxfaca <br /> . Pip Qrout <br /> Distance to sewer Iine <br /> Domestic well on site - (y/ n) <br /> If yes, location and distance - <br /> SAMPLING 50 O stared <br /> •odcn r <br /> Holding Temperature &0 15E5 Fem Ste► _ <br /> Vavd pads <br /> Method — <br /> �Y• - <br /> Screening Method ""' - • ,,' <br /> Tracking Sheet - (y/ nIF) <br /> ....,..,...._i�. _.,...... — tt. <br /> SPOILS <br /> Storage Method (,A /Ar(JVIA.S �� `�'` �) MATERIALS/DEVELOPMENT <br /> Contamination Noted - n ) Z it 7�O G <br /> Storage Location Casing type t <br /> Blank - ft. t Screen <br /> SIot size OZa <br /> GROUTING Bags cement ! <br /> Buckets bentonite. f had <br /> Depth to Nater Bags sand/gravel E5- <br /> Mix <br /> Mix Ratios . LD / [DaA RY'fb C TY Filter Pack type/size -4 <br /> Installation Meffiod -V4rAm05 Surge Block: - ( y/Fogist: <br /> Quantity Installed Discussed with geo - n ) <br /> Type of method <br /> EH 29 29 <br /> [csilc_ -f-yemmte, . PC. <br /> i Crti� -films -E�tLeA, <br />
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