Laserfiche WebLink
SMJOAQUIh <br /> Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> 2 Monitoring Well/Soil Boring Inspection Report <br /> 1 l <br /> Date:Zl iZ Inspector: tA) CONSTRUCTION <br /> Facility Address: aye <br /> Well Address: Total Depth: <br /> WP# Well#: ( Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: r-' _ Filter Pack From: To: <br /> Geologist: entonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑ o _ COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑ o casing <br /> If yes, location and distance: es height <br /> - i� ++_ _CrT <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CONFLETION cCOMP.EnoN <br /> Method: <br /> Ground Surface <br /> Screening Method: �� grout <br /> Verified Chain of Custody: ❑ Yes ❑ o r; �n' <br /> �j ii Q� / ft. <br /> SPOILS v�V ,J <br /> Contamination Noted: ❑ Yes ❑Nod <br /> If yes, spoils storage Location: slotted <br /> soon <br /> Covered: ❑ Yes El <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: Ktt• tt. <br /> Grout Material ice,, <br /> � MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation *ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> _X <br /> Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity remie ❑Other: Type of Method: <br /> kS lk PAC <br /> Water Cement 471b Water Cement 941b �• <br /> allons Bags gallons Ba s <br /> Thickest Thinnest uBa s Thickest Thinnest ttBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 5 10 1 Bentonite per47 lb 1.41 2.47 <br /> 0� 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 jjq7 <br /> 20 40 4 <br /> 12.5 25 25 50 5 <br /> 15 30 30 60 6 <br /> 17.5 35 35 70 120 40 40 ` 80 8 <br /> 9-7-11 10/16/2 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com JA <br />