Laserfiche WebLink
SANsJOAQUIN <br /> Environmental Health Department <br /> COUNTY <br /> Greotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: A Inspector: a t (1,,;, CONSTRUCTION <br /> Facility Address: 0\%lu <br /> Well Address: oo*' Total Depth: <br /> WP# �'j u',kI I i Well#: Drilling Rig Type: <br /> Soil Boring#: \_1L Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: <br /> Filter Pack From: To: <br /> Geologist: u 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 ABOVE-GROUND <br /> Holding Temperature: 006PLETION CVAPP ET1oN <br /> Method: Ground Surface <br /> Screening Method: grotA <br /> Verified Chain of Custody: ❑ Yes El No n' <br /> tt. <br /> ft. <br /> SPOILS - — <br /> Contamination Noted: ❑ Yes El No <br /> If yes, spoils storage Location: slotted <br /> sscdon <br /> Covered: ❑ Yes ❑No <br /> wavel Pack <br /> If yes, material: <br /> IF <br /> GROUTING or DESTRUCTION Total Depth: gi <br /> Depth to Water: IF n' <br /> Grout Material: IL ,:._ ( s <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation �$oring Destruction gags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity RTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> Rall s Bas eallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest ttBags 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 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />