Laserfiche WebLink
• ! `�.�+ 'ryr: � —COUNTY Environmental Health Department <br /> ��._;�-'•' G;eotness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I 2 Inspector: � _ CONSTRUCTION <br /> Facility A dre s: ILLaJt - <br /> Well Address: v Total Depth: <br /> WP# DO Well#: Drilling Rig Type: _ <br /> Soil Boring#: ( — Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: P'� <br /> Driller Onsite: �Il'i. Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: A 101 Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> IF <br /> SAMPLING AWVE-{ROUND <br /> Holding Temperature: CO 10� C-CWLEriiON <br /> Method: ClrW d8Wm--' <br /> Screening Method: Grout <br /> Verified Chain of Custody: ❑ Yes ❑No fL <br /> ft. <br /> SPOILS <br /> Contamination Noted: El Yes ❑No 0 <br /> If yes,spoils storage Location: Slotted <br /> srcon <br /> Covered: ❑ Yes ❑No = 9-01 pack <br /> If yes, material: 1 <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: 1llC MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags of Cement: <br /> METHOD USED (( Bags Sand/Gravel: <br /> Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity N�Fremie ❑Other: Type of Method: <br /> Water Cement 47lb Water Cement 941b <br /> gaa 111 Bags llons Bags <br /> Thickest Thinnest ti Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5%Mix <br /> 2.5 5 1 5 10 1 _Bentonite per 47 Ib 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 715 15 3 15 30 3 ; <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 /> 13 bg s(�0lbc) --t- 55 �aWv b `1w ow 10/16/2017 <br /> 1868 E. Hazelton Ayenue f Stockton,California 95205 17 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />