Laserfiche WebLink
SAN,�J0AQUIN Environmen,_,4 Health Department <br /> ILI " —COUNTY— <br /> �';,jF�,��' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date.w�o•� 10`)ZInspector: CONSTRUCTION <br /> Facility Address: _ ( \ <br /> Well Address: bo4 z� 5� x Total Depth: <br /> � <br /> Wp# v� _Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes []No <br /> Drilling Company:. <br /> osctl� Screen Length From: To: <br /> Driller Onsite: P <br /> M� - �`N 7 Filter Pack From: To: <br /> Consultant: <br /> 1 Sxc� M� Bentonite From: To: <br /> Geologist: IIDtA <br /> Grout From: To: <br /> Public Water System Onsite: qp Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: v❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND CHStm-Box <br /> Holding Temperature: 006'PLETION COMPLETION <br /> Method: orouMS rlacs <br /> Screening Method: grow <br /> Verified Chain of Custody: ❑ Yes ❑No n; <br /> SPOILS _ <br /> _ a <br /> Contamination Noted: ❑Yes ❑No ^e <br /> ;tit. �. •.. s2 <br /> If yes,spoils storage Location: #monad <br /> a4cdon __ 8 <br /> ❑ Yes ❑No <br /> Covered: gravol Pack <br /> If yes,material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: 1"S%�c V p ft• — tt. <br /> Grout Material: ±'l t MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation INBoring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity kTremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> f17. <br /> ns Ba s allons Bags - <br /> 7hlnnest #Bags Thickest Thinnest #Bags _ Bentonite/Cement Mix 3%Mix 5"/o Mix <br /> s s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 1 2 10 20 Bentonite per 941b 2.82 4.7 <br /> 15 3 15 30 3 <br /> 20 4 20 40 4 <br /> 25 5 25 50 5 <br /> 30 6 30 60 6 <br /> 35 7 35 7a 7 <br /> 20 40 a 40 80 B <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 />