Laserfiche WebLink
SAN J OAQ U I N Environmental health Department <br /> COUNTY <br /> .,rar.nes; qn .-: here. <br /> Ill nitorin Well/Soil Boring Inspection Report <br /> Iia ( �o <br /> Date. I � Inspectors � CONSTRUCTION <br /> Facility Address:--6.01 G rar» /tie <br /> Well Address: '1 raW Total Depth: <br /> WP# 00-3M q well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: 20.y-,q CCS+ <br /> Driller Onsite: ��� Screen Length From: To: <br /> Consultant: 1C6� Filter Pack From: To: <br /> .R rxckGeologist: wi s a a,t(4 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ASOVE-GROUND <br /> Holding Temperature: CO&FLETION cPLEMN <br /> Method: G=r)d Surface <br /> Screening Method: gr«n <br /> Verified Chain of Custody: ❑ Yes ❑No fl. <br /> SPOILS —_ <br /> _ a <br /> Contamination Noted: ❑ Yes ❑No = m <br /> If yes, spoils storage Location: <br /> slcrnd — � <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: go CC — <br /> Depth to Water: <br /> Grout Material: T <br /> Gallons of Grout Used: o ��(p�✓j MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity [ATremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gaI1111 s Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 20 4 20 40 4 n <br /> 12.5 , 25 5 25 50 5 <br /> 155 30 30 60 6 <br /> 17.5 1 35 7 7 35 70 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />