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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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C
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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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it <br /> Mu NTITORING WELL INSTALLATION REPOni <br /> Date: 7� / " CONSTRUCTION L <br /> Premise Address: Ci C Total Depth 2 / <br /> �� Screen Length (from) (to) �g <br /> Well No. : �! Filter Pack (from) 2! (to) <br /> Bentonite (from) (to) co <br /> Inspector: v( Grout (from). (to) <br /> Drilling rig type 44 <br /> Permit No. V70 Auger O.D. I.D. <br /> Completion . Stove pipe/christie box (circle one) <br /> Drilling Comp\a y: <br /> Driller: Y ` ��w casing <br /> n _ I height <br /> Consultant l <br /> Geologist dgpyE.GgpUND &OMP= <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Cround Surlacs 7 _ <br /> la grout <br /> Distance to sewer line � <br /> Domestic well on site - ( y( n• <br /> If yes, location and distance - 10 $ n• <br /> n a� <br /> Voodoo <br /> do <br /> odowdo <br /> SAMPLING slotted <br /> e sec5on —_ <br /> Holding Temperature to L - gmyel Pack <br /> Method = <br /> Screening Method = <br /> Tracking Sheet - ( y / n ) Voodoo, T <br /> SPOILS <br /> Storage Method &XVdf t � MATERIALS/DEVELOPMENT <br /> Contamination Noted - ( y / n ) Lf 't �+ <br /> Storage Location Casing type <br /> Blank 10 ft. Screen 45 ft. <br /> Slot size_ 1D W <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water Bags sand/gravel <br /> Mix Ratios ti" ca Filter Pack type/size 2 l'� <br /> Installation Metho �B "^ Surge Block: - ( y n <br /> Quantity Installed ;L / Discussed <br /> ss d with geo ogist: - ( y <br /> Type <br /> EH 29 29 <br />
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