Laserfiche WebLink
SAN JOAO UIN Environmental Health Department <br />—COUNTY <br />Monitoring Well/Soil Boring Inspection Report <br />Date: ISI -M Inspector: r, <br />Facility Address: I t I (� <br />Well Address: 11113(�uv U <br />WP# V Y 5 r Well#: <br />Soil Boring#: <br />Drilling Company: A&A ('1m' 2 1 j\1n�1 <br />Driller Onsite: "f'e I CIMD <br />Consultant: <br />Geologist: <br />IlA rock rca�� ^"Public Water System Onsite: Yes ❑No <br />Domestic Well Onsite: ❑ Yes El No <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: ❑ Yes ❑ No <br />SPOILS <br />Contamination Noted: ❑ Yes 0 N <br />If yes, spoils storage Location: <br />Covered: ❑ Yes ❑ No <br />If yes, material: <br />GROUTING or DESTRUCTION Total Depth: 4C� <br />Depth to Water: 9-60 Material: 1+Vftlt­j") <br />Gallons of Grout Used: <br />,Well Installation ❑Well Destruction <br />❑Boring Installation ❑Boring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity XTremie ❑Other: <br />Water <br />Ilons <br />Cement 471b <br />Bas <br />Water <br />gallons <br />Cement 94 lb <br />Bags <br />Thickest Thinnest <br />#Bags <br />Tld:kas? <br />s <br />hirine;,_ <br />1 to <br />ARags <br />1 <br />2.5 5 1 <br />5 10 <br />2 <br />10 <br />20 <br />2 <br />7.5 15 <br />3 <br />15 <br />30 <br />3 <br />10 20 <br />4 <br />20 <br />40 <br />4 <br />12.5 25 <br />5 <br />25 <br />50 <br />5 <br />15 30 <br />6 <br />30 <br />60 <br />6 <br />17.5 35 <br />7 <br />3570 <br />7 <br />20 40 <br />8 <br />40 <br />80 <br />8 <br />CONSTRUCTION <br />Total Depth: 4q) <br />Drilling Rig Type: _ <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite <br />Grout <br />rnMDI FTInN <br />From: <br />From: <br />From: <br />From: <br />❑ Stove Pipe <br />❑ Yes 0 N <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />casing <br />height - <br />AWVE-GROUND <br />COMPLETION ION c1' -BOX. <br />con�t3met-u=riots <br />Gmuna Sumacs <br />grout <br />ft_ <br />tt. <br />ft. <br />— o <br />slottad _ 3 <br />sacycn <br />�€ = gravel pack <br />ft. <br />MATERIALS/DEVELOPMENT <br />Casing Type: <br />Blank Feet <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite/cement Mix 3 FAix 1 5°4o Mix <br />(Benionite_per 41 Ib 1.4'1 2.4 <br />Bentonite per 94 lb 2.821 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 />