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FIELD DOCUMENTS FILE 3
Environmental Health - Public
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EHD Program Facility Records by Street Name
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COUNTRY CLUB
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2575
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2900 - Site Mitigation Program
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PR0541989
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FIELD DOCUMENTS FILE 3
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Last modified
6/21/2019 5:35:21 PM
Creation date
6/21/2019 3:22:11 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
FileName_PostFix
FILE 3
RECORD_ID
PR0541989
PE
2950
FACILITY_ID
FA0024100
FACILITY_NAME
COUNTRY CLUB VALERO
STREET_NUMBER
2575
STREET_NAME
COUNTRY CLUB
STREET_TYPE
BLVD
City
STOCKTON
Zip
95204
APN
12302012
CURRENT_STATUS
01
SITE_LOCATION
2575 COUNTRY CLUB BLVD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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I <br /> MONITORING WELL INSTALLATION REPOn . <br /> i <br /> I <br /> Date: ! ' 50 d r CONSTRUCTION <br /> Premise Address : % CCS L Total Depth Cie) <br /> p Screen Length (from) (to) 2-0 <br /> Well No. : ' �Q Filter Pack (from) 3 (to) 243 <br /> Bentonite (from) 3 (to) I <br /> Inspector: Grout (from) (to) 0 <br /> ci Drilling rig type <br /> Permit No. Auger O.D. / y I .D. 6 <br /> Completion - Stove pipe/christie bo (circle one) <br /> Drilling Company: f <br /> Driller: casing <br /> height <br /> Consultant�✓�'t�/ T <br /> Geologist � <br /> ABOVE-GROUND <br /> COMPLETION CHR <br /> LETION <br /> SPECIAL PERMIT INFO, Ground Surface <br /> Distance to sewer line RR <br /> grout <br /> Domestic well on site - ( y / n ) <br /> If yes, location and distance - ft' <br /> ft. <br /> ft. <br /> c <br /> SAMPLING slotted kr c <br /> section <br /> Holding Temperature <br /> Method — `'✓ gravel P <br /> Screening Method = _ <br /> Tracking Sheet - ( y / n ) <br /> SPOILS <br /> Storage Method MATERIALS DEVELOPMENT <br /> Contamination Noted ( r n <br /> Lyf ! <br /> Storage Location Casing type <br /> Blank 5 ft. Screen /S ft. <br /> Slot size .Q -ZZ <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water (9 ( 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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