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FIELD DOCUMENTS
Environmental Health - Public
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EHD Program Facility Records by Street Name
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MARIPOSA
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2132
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2900 - Site Mitigation Program
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PR0541650
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Last modified
3/11/2020 8:18:41 PM
Creation date
3/11/2020 2:33:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2900 - Site Mitigation Program
File Section
FIELD DOCUMENTS
RECORD_ID
PR0541650
PE
2960
FACILITY_ID
FA0023868
FACILITY_NAME
FORMER USA GASOLINE SERVICE STATION 110
STREET_NUMBER
2132
Direction
E
STREET_NAME
MARIPOSA
STREET_TYPE
RD
City
STOCKTON
Zip
95205
APN
1730635
CURRENT_STATUS
01
SITE_LOCATION
2132 E MARIPOSA RD
P_LOCATION
01
QC Status
Approved
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EHD - Public
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VONITORING WELL INSTALLATION REPCO - G Lt/-9-ff-� <br /> Date:�!'u—2-Y �c L _ ( CONSTRUCITON- • -. <br /> Premise Address: (P'( Z��E,�•,,// �Sti a�cc >v4t STotal Depth L VA-t '�Y <br /> Well No.: ,Z( VIZ 'j �G'I( 1471 mow//creen Length (from) (to) <br /> 1 Filter Pack (from) (to) <br /> /� Bentonite (from) (to) <br /> Inspector: 61-t Grout (from) (to) <br /> << Drilling rig type <br /> 1 <br /> Permit No.-5R—*60 6 q5i� Auger O.D. I.D. <br /> Drilling Company:AwA Completion - Stove pipe/christie box (circle one) <br /> Driller: <br /> casing <br /> UL+M,MA� Ci� T height <br /> Consultant (,-""- "'. ` <br /> Geologist T <br /> ABOVE-GROUND <br /> COMPLETION GI-S STY-BOX <br /> COMPLETION <br /> SPECIAL PERMIT INFO. Ground Sulace <br /> Distance to sewer line grout <br /> Domestic well on site - (y/ n ) �—tt <br /> If yes, location and distance - <br /> —n. <br /> ft. <br /> = m <br /> — o <br /> SAMPLING = ° <br /> tlattad _ B <br /> Ov tocicn = <br /> Holding mperature = <br /> MethodacK <br /> - fl ° v <br /> Screening Method <br /> Tracking Sheet - ( / n ) <br /> SPOILS <br /> Storage Method MATERIALS/DEVELOPMENT <br /> Contamination Noted - <br /> Storage Location51, Casing type <br /> Blank ft. Screen ft. <br /> Slot size <br /> GROUTING Bags cement <br /> Buckets bentonite <br /> Depth to water 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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