Laserfiche WebLink
r. r�1N SAN 10AQUIN Environmental Health Department <br /> i=5 f'•��- �J — COUNTY— <br /> • <br /> °HctFnn;`�5 Greo'tness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: � ;_3Inspector: CONSTRUCTION <br /> Facility Address: - w� �� ✓ <br /> Well Adder/es : Total Depth: <br /> WP# y Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No <br /> Drilling Company: Screen Length From: To: <br /> Driller Onsite: � �a`''` <br /> Consultant: U• Filter Pack From: To; <br /> Geologist: o <br /> Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe El Christie Box <br /> Domestic Well Onsite: ❑Yes ❑No Qas3.n5 <br /> If yes,location and distance: <br /> SAMPLING AB iVgg&PWND <br /> cx�Mi'i�'rx�N rs��r-sox • <br /> Holding Temperature: P ,PN <br /> Method: GmOnd Surtaca <br /> Screening Method: gfout <br /> Verified Chain of Custody: ❑Yes ❑No ' <br /> SPOILS <br /> ❑Yes ❑N o <br /> Contamination Noted: = m <br /> :gY � �• c <br /> If yes,spoils storage Location: <br /> s4taon • • "" <br /> Covered: ❑Yes ❑Now,.= „ <br /> If yes,material- <br /> GROUT[N G.or-D ESTRU CTION Total Depth:_.. • - <br /> Depth to Water: ' ' <br /> Grout Material: /1 e.--�--Gin t? MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation R*ell Destruction Blank Feet Screen Feet <br /> Slot Size:- <br /> Boring Installation El Boring 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 *Tremie JCOther: i/�"�� Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Be allons Bags <br /> Thickest Thinnest NBags Thickest Thinnest kBags Bentonii;ef{'",anent Mix 3% Mix 5% Mix <br /> 2,5 5 1 s 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 C3�r-C <br /> 1s *4'0 <br /> 6, 30 60 6 <br /> 1715 7 35 70 7 <br /> 20 0 40 80 B <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 T 209 468-3420 1 F 209 464-0138.1 www.sicehd.com <br />