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WP0041202
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4200/4300 - Liquid Waste/Water Well Permits
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WP0041202
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Last modified
3/2/2021 2:13:26 PM
Creation date
3/2/2021 2:04:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4200/4300 - Liquid Waste/Water Well Permits
RECORD_ID
WP0041202
PE
4372
STREET_NUMBER
1200
STREET_NAME
HUMPHREYS
City
STOCKTON
Zip
95203-
APN
16203007
ENTERED_DATE
9/8/2020 12:00:00 AM
SITE_LOCATION
1200 HUMPHREYS
P_LOCATION
01
P_DISTRICT
003
QC Status
Approved
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SJGOV\tsok
Tags
EHD - Public
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SAN <br /> f_ 10AQUIN Environmental Health Department <br /> ---COUNTY---- <br /> Greatness <br /> COUNTY- - <br /> Greatness grows here <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector. A • l `v�(AS CONSTRUCTION <br /> Facility Address: o� Y►� (AS. <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: gLG]F"rZ Min 2"Annular EHD Seal Verified: ❑ Yes 1-1 No <br /> Drilling Company: beo 1iC. <br /> Driller Onsite: � LAP— Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: �y_'(,p 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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING A80VE.GAOUNO <br /> Holding Temperature: COMPLETION �OMP�LET1oN <br /> Method: Ground Surface <br /> Screening Method: &I gran <br /> Verified Chain of Custody: ❑ Yes ❑No �ft• <br /> h. <br /> I R <br /> ft. <br /> SPOILS =_ <br /> — - a <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: <br /> started <br /> sacdon = B <br /> Covered: ❑ Yes ❑No <br /> If yes, material: Ei <br /> GROUTING or DESTRUCTION Total Depth: <br /> ��,,tt� _ <br /> Depth to Water: ►�� �2 CT" n. n' <br /> Grout Material: M efk - yP-W`e Al - MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: AU ( . <br /> 1.10 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑ Slot Size: <br /> Boring Installation 413oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity EITremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest .1 Baas Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> i5 5 1►1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 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 T 209 468-3420 1 F 209 464-0138 1 www.smcehd.com <br />
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