Laserfiche WebLink
=c: SAN JOAQUIN <br />Environmental Health Department <br />— COUNTY <br />ctkFoaayP' Greutness grows heft <br />Monitoring Well/Soil Boring Inspection Report <br />Date: > ��' Z� Inspector: �C�`�rlGti <br />Facility Address:' ,S`Cc� �; e J tiv�i 1i a Qr <br />Well Address: <br />WP# C -"o LA k Well#: <br />Soil Boring#: <br />Drilling Company: V=Cc�i,'N <br />Driller Onsite: C'GACk `t e <br />Consultant: r1 <br />Geologist: C - <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: ❑ Yes ❑No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody <br />wnli c <br />Contamination Noted <br />If yes, spoils storage Location: <br />❑ Yes ❑ No <br />❑ Yes ❑ No <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: �G . <br />Depth to Water: <br />Grout Material: <br />rr)KICTRI irTlnN <br />Total Depth: _ <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnMPi MON <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes ❑ No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />—5height <br />1 —ww-f <br />ABOVE -GROUND Crwsm-sox <br />COMPLETION COMPLETION <br />Ground solace <br />grout <br />ft. <br />fl. <br />n. <br />= o <br />slotted <br />seCion <br />n. " n - <br />Gallons of Grout Used: /,MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />❑Boring Installation 1�rBoring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity ZTremie ❑Other: <br />Water <br />allons <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Cement 471b <br />Bas <br />Filter Pack Type/Size: <br />Type of Method: <br />Water <br />allons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />t7 Bags <br />Thickest Thinnest <br />tlBags <br />2.5 <br />5 <br />1 <br />5 <br />10 <br />1 <br />5 <br />10 <br />2 ✓ <br />10 <br />20 <br />2 <br />7.5 <br />15 <br />3 <br />15 <br />30 <br />3 <br />10 <br />20 <br />4 <br />20 <br />40 <br />4 <br />12.5 <br />25 <br />5 <br />25 <br />50 <br />5 <br />15 <br />30 <br />6 <br />30 <br />60 <br />6 <br />17.5 <br />35 <br />7 <br />35 <br />70 <br />7 <br />20 1 <br />40 <br />8 <br />40 <br />80 <br />8 <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 />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />