Laserfiche WebLink
P'U y'''� <br /> S A Kltd 0 A 0 U I N Env"Rronmenta� Health Deparhme-Ant <br /> COUNTY <br /> Greatness grows here. <br /> =rr'cr <br /> Monitori g Well/Soil Boring Inspection Report <br /> Date: �V-Inspector: CONSTRUCTION <br /> Facility ddress: 'O� <br /> Well Address: Total Depth: <br /> WP# ��-`�"��'O Well#; Drilling Rig Type: <br /> Soil Baring#: 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: ::XA C Screen Length From: To: <br /> Consultant: Filter Pack From: To; <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: I"Yes ❑No COMPLETION ❑ Stove Pipe []Christie Box <br /> Domestic Well Onsite: Yes El No easing <br /> If yes, location and distance: height <br /> SAMPLING dWVE�ROUND _ <br /> Holding Temperature: COWLETION CHMSWCOMPLE-80 <br /> ON <br /> Method: Grodnd Surfaco <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No _ft- <br /> y <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No == <br /> If yes, spoils storage Location: p <br /> alonad vi m <br /> aeon = <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> �.. <br /> Depth to Water: �- <br /> Grout Material: <br /> Gallons of Grout Used: <br /> MATE RIALS/DEVE LOP M ENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑ Slot Size: <br /> Boring 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 'AXxwi* ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> g�all Bags vallons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 10 20 2 Bentonite per 94 lb 2.82 4.7 <br /> 7.5 15 3 15 30 3 1 1 <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 /> 1.0/16/201.7 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 T 209 468-3420 F 209 464-0138 1 www.sicehd.com <br />