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ARCHIVED REPORTS_XR0004604
Environmental Health - Public
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3500 - Local Oversight Program
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PR0545482
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ARCHIVED REPORTS_XR0004604
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Last modified
3/10/2020 12:53:31 PM
Creation date
3/10/2020 8:55:46 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004604
RECORD_ID
PR0545482
PE
3528
FACILITY_ID
FA0005075
FACILITY_NAME
DONS MOBILE GLASS
STREET_NUMBER
151
Direction
S
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
953365719
APN
21941015
CURRENT_STATUS
02
SITE_LOCATION
151 S MAIN ST
P_LOCATION
04
P_DISTRICT
005
QC Status
Approved
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SJGOV\sballwahn
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EHD - Public
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q <br /> AF <br /> 1 Park <br /> Env+ronntenta1 11 <br /> Leav�ng A Clean Environment ' <br /> �t�, WELL DEVELOPMENTISAMPLING DOCUMENTATION FORM <br /> Protect Name � ,I'�,1 n. A032_ L <br /> .lob# <br /> Date <br /> Sarn hn Team <br /> (Names/Responsibilities) <br /> Purpose of Sampling Initialrteriy Verfiication other <br /> Weather Conditions <br /> GRO NDWATER LEVEUCASING VOLUME <br /> i3e th Total Feet of Conversion casing Volume <br /> Time TQC to GW Depth Water Factor Gallons <br /> Initial a s <br /> After develo J ur m <br /> At time of Sampling Three Casing Volumes Gals <br /> Ten Casing Volumes Gals <br /> WELL DEVELOPMENTiPURGING <br /> Equipment Swab-AireSub Pum Bader Sandpiper Other <br /> Method Description ` <br /> Decontamination Method <br /> Water Containment d ums baker tank other <br />` taheied Q <br /> Pum Vol Water Temp EC Observations <br /> Time hate Extracted umhns H calor,turbid+ ,ods odor <br />� <br /> Start � � <br /> 1 fll 4 <br /> l <br /> - y1 <br /> SAMPLE INFORMATION <br /> Lab <br /> Sampling Containers/Number of Containers/Analysis Preservation Description <br /> 1 Liter Amber Ice and <br /> 21 40 ml Voa + , x ice and - <br /> Other Ice and <br /> Time <br /> Device Disposable eso Bader v----�- Other <br /> P Intent Ftel _Q�sefvatins <br /> F <br /> Deviations from Standard Sampling Protocol <br />
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