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ARCHIVED REPORTS_XR0004432
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545347
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ARCHIVED REPORTS_XR0004432
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Last modified
2/6/2020 5:09:55 PM
Creation date
2/6/2020 3:39:29 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004432
RECORD_ID
PR0545347
PE
3528
FACILITY_ID
FA0003685
FACILITY_NAME
DBA CIRCLEK, REFUEL PETROLEUM INC.
STREET_NUMBER
419
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21938610
CURRENT_STATUS
02
SITE_LOCATION
419 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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EHD - Public
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i <br /> c,O DO E TH TE—CH OL GES - <br /> 788 Frank West Circle,suite f,Stockton CA 96206 GROUNDWATER MONITORING FIELD FORM <br /> 1 SITE:_&gxv [ WELL ID: lf(41— <br /> PROJECT NO: CONDOR PERSONNEL: 77 <br /> AMBIENT CONDITIONS (Circle): fa1r)adverse (describe in notes section) DATE: 3../ p <br /> 2 PRE-PURGE DATA: Purge Volume Protocol (#of casing volumes),.__ 3 — <br /> Well Cas. Depth (ft.) rt 10 (Circle: measured/detail Well Casing Diameter(in,) 2�� <br /> - Depth-to-Water 17•Z$ (subtract from well casing Depth) Measuring Point Location <br /> =Water Colurnn" 2.5 Purge Voi. Calc, (for 1 casing vol.) .-3's =_L 2.S (multipliers:2 inch=.163, 4 inch=.653, 5 Inch=1.02) <br /> Field Inspection Sam Appearance: ` Odor: <br /> (Specify color,degree of cler!!y,presence of sheen or product phase) (Specify alight,moderate,or strong) <br /> t� <br /> 3 PURGE DATA: Purge Device: ,*sInc <br /> If pumped,specify: discharge rate (gpm) depth pump set at(ft.) <br /> ILIDe Volume Purged Temperature E-0- If well purges dry, specify the following: <br /> iANi-LEM (start) (cumulative) (circle: t"/a 1) time <br /> ` 2) volume purged <br /> 3) depth to water <br /> 4) depth to water for 80%recovery <br /> -� M�M 5) depth to water at time of sampling <br /> Tota!Val. Purged (gals.) <br /> 4 SAMPLING DATA: Nq_pf Contaln. Tyne of Container ELe-quested Analysis <br /> 1 TO C> Time Collected <br /> Collection ice •f <br /> Samp#e IbDev7 <br /> 5 QAIQC_SAMPLES; Duplicate (circle): Yes,q Sample ID <br /> Rinsate on sample collection device used on this well (circle): Yes Nn Sample 0 <br /> 6 DECONTAMIN.kT14_DLMethod (circle) tandard Procedur /Other <br /> (Standard decontamination procedure consists of washing gear with a soiution of organic pure water and liqulnox and then double rinsing with organic pure water,If another method Is used,describe In the field notes section.) <br /> 7 ADDITIONAL FIELD NOTES: /V. + Vim je �or l,'1w, _ ,�''^e•,* 1 ad <br /> OVorms\Field Formslgwmff gwmff.XIS <br />
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