Laserfiche WebLink
SAWd0A0UIN <br />z Environmental Health Department <br />—COUNTY— <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: Inspector: <br />Facility Address: i'll li 5&Z At 6i' C rr <br />Well Address: <br />W P #. ex) bS6& 5-2 Well#: <br />Soil Boring#: I <br />Drilling Company: ?..r%fe'%t <br />Driller Onsite: <br />Consultant: k/e:n ft 0 - <br />Geologist: X6,01 <br />Public Water System Onsite <br />Domestic Well Onsite <br />If yes, location and distance: <br />CflKAPI Mir; <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />❑ Yes ❑No <br />❑ Yes ❑ N o <br />Verified Chain of Custody: ❑ Yes ❑No <br />SPOILS <br />Contamination Noted: ❑ Yes ❑No <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: �C <br />Depth to Water: Irl <br />Grout Material: Nekjt- (0&y -.e <br />Gallons of Grout Used: <br />❑Well Installation ❑Well Destruction <br />❑Boring Installation N$$oring Destruction <br />MFTNrin I ICFs <br />ZPressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />allons <br />Cement 471b <br />Bags <br />Water <br />wallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />#Bags <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />5 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />75 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />V <br />40 80 <br />8 <br />CONSTRUCTION <br />Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br />Screen Length <br />From: <br />To: <br />Filter Pack <br />From: <br />To: <br />Bentonite <br />From: <br />To: <br />Grout <br />From: <br />To: <br />COMPLETION ❑ Stove Pipe ❑Christie Box <br />casing <br />height <br />Til <br />I <br />T <br />ABOVE -GROUND C7-iRj� - Y-3ox <br />COWLETJON COMPLETION <br />crocina suras <br />grout <br />ft_ <br />ft. <br />= o <br />_ — o <br />sacyon <br />use pack <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite/Cement Mix 3% Mix 5% Mix_ <br />Bentonite per 47 Ib 1.41 2.47 <br />Bentonite per 94 Ib 2.82 4.7 <br />27�r�o� 10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, Califomia 95205 1 T 209 468-3420 1 F 209 4640138 1 www.sicehd.com <br />