Laserfiche WebLink
c°z SAN IOAQUIN <br /> � Environmental Health Department <br /> " —COUNTY-- <br /> �C` �i Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: L5 v Inspector: �tky_',tcp �c g ,� CONSTRUCTION <br /> Facility Address: I` <br /> Well Address: �b11S Carw� til r�yt JSccIP� Total Depth: <br /> WP# ;`� ' av <br /> L Well#: � Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: N\w,t\\,S �rl\'.�g SQL Screen Length From: To: <br /> Driller Onsite: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: TV height <br /> SAMPLING ABOVE-GROUND <br /> e <br /> Holding Temperature: COnoN C-O#A en <br /> t�� t <br /> Method: G=n°Sudaoe <br /> Screening Method: a.«n <br /> Verified Chain of Custody: ❑ Yes El No —`---n' <br /> is. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: sbhad <br /> soon — B <br /> Covered: ❑ Yes ❑No <br /> g-vw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: TO <br /> Depth to Water: n- n' <br /> Grout Material: )4141LIA (1 c "l a ��� . MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> nWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation El Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest Jt Bags Thickest Thinnest 0Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 s 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 s <br /> 12.S 25 5 25 50 5 �'`✓"S r <br /> 15 30 6 30 60 6 \s <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 L �t S <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-34201 F 209 464-0138-1- www.sicehd.com <br />