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FIELD DOCUMENTS FILE 1
Environmental Health - Public
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EHD Program Facility Records by Street Name
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C
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COUNTRY CLUB
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2103
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3500 - Local Oversight Program
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PR0544591
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FIELD DOCUMENTS FILE 1
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Last modified
6/21/2019 2:26:57 PM
Creation date
6/21/2019 11:30:06 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 1
RECORD_ID
PR0544591
PE
3526
FACILITY_ID
FA0005220
FACILITY_NAME
CHEVRON #9-4054
STREET_NUMBER
2103
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12308029
CURRENT_STATUS
02
SITE_LOCATION
2103 COUNTRY CLUB BLVD
P_LOCATION
99
P_DISTRICT
001
QC Status
Approved
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EHD - Public
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MC' TOPING WELL NS7ALy' ;ION R PORT <br /> Da[z: <br /> Z�` C Z CONS RUCTION <br /> /J /���® � <br /> Premise Address: a'21 3 4y6 Tocal Depth �D <br /> Screen Length (from) 30 (to) IS <br /> Well No.: Filter Pack (from) 30 (to) 13 <br /> Bentonite (from) I3 (to) 11 <br /> Inspector Grout (from) II (to) O <br /> Drilling rig type 1353 <br /> Permit No. 3 0 Auger O.D. I.D. <br /> Completion - Stove pipe/chrsde box (circle one) <br /> Drilling Company. <br /> _ casing <br /> Driller: —The <br /> Consultant' (5�"2"8"+�u�K/ !'zek LJ <br /> 00� /� ABOVE-GROUND \ <br /> G20lOg[SL CFiAISY3CX <br /> CO&FL-I CCN COMPL=i ICN <br /> Ground Sulact <br /> SPECIAL PERMIT INFO. <br /> grout <br /> Distance to sewer line <br /> ft. <br /> Domestic well on site - (y/ n) <br /> /3 ft <br /> If,yes, location and distance - 15, ft. <br /> 'aK.. <br /> O <br /> a <br /> C <br /> O <br /> sicRDd <br /> SAMPLING t�eion _ <br /> a <br /> gnVe,pack <br /> Folding Tempera[ure — I <br /> Method e ' <br /> Sceening Method mer 6, 1,L�-7 <br /> TrackLig Sheet - y n ) 30 ft. r = * -ft. <br /> SPOILS <br /> Storage Method W MAicRlALS/DEVELOPMENT <br /> Contamination Noted - y n ) 2 <br /> Storage Location Casing type <br /> Blank__-4ifr. Screen 1 ft. <br /> Slot size <br /> GROUTING Bags cement B <br /> Buckets bentonite 1 <br /> Depth to water Bags sand/gravel <br /> Mbc Rados_ JOD*'66 772 > Filter Pack type e <br /> Installation Method Surge Bloc..i - n ) <br /> 3war YL Discussed with geologist: - { n <br /> Quantiy Installed 6een ) <br /> Type of method y <br /> CC' <br /> z <br />
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