Laserfiche WebLink
f 6 � 5ANA0A UI N <br /> � " Environmental Health Department <br /> —COUNTY— <br /> •�• �0 Greatness rows here. <br /> .S soa,. 9 <br /> Monitoring Well/Soil Boring Inspection Report �j <br /> Date: Inspector: �a ivr�S CONSTRUCTION Note-. <br /> ; <br /> Facility Address; <br /> Well Address: Iti rSQ� �Total Depth: n�-� <br /> WP# �Q�$ Well#: _ Drilling RigType: b Soil Boring#: Min 2"Annular EHD Seal Verified: ❑Yes ❑No ^"n�/ L, <br /> Dri111ngCompany: h W r'/j�(�Jr <br /> DrillerOnslte: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: coy\nor ' Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ONo COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑Yes []No aaaing <br /> If yes,location and distance: a�ieht <br /> SAMPLING <br /> J4BOVtiA011tl0 CaMPIl=710N <br /> Holding Temperature: WLiF'LETION <br /> Method: kocnasurr,c+-Z »— <br /> Screening Method: Qrout <br /> Verified Chain of Custody: ❑Yes ❑Noft. <br /> SPOILS <br /> Contamination Noted: ❑Yes []No �, o <br /> EE <br /> If yes,spoils storage Location: E <br /> saelan -+ •8 <br /> Covered: ❑Yes []No `— <br /> .„�: phvetpade , <br /> If yes,material: <br /> GROUTING-or-DESTRUCTION.Total Depth:-l'.s--- ..,. _ <br /> EE <br /> DepthtoWater: <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> OWell Installation KNell Destruction Blank Feet Screen Feet <br /> ❑Boring Installation OB Slot Size:oring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout OOverDrill Filter Pack Type/Size: <br /> Gravity OTremie ❑Other: Type of Method: <br /> Water ant 471b Water cemant941b <br /> lion ass Rallons 8e <br /> Thickest Thinnest gs Thickest 'Thinnest HBags .BBntonitelGetilent MtX 3%Mix 5%Mix <br /> zs s i s in I Bentonite per 47lb 1.41 2.47 <br /> s io z IO 20 z I Bentonite per 94lb 2.82 4,7 <br /> 7.5 is s is so 0 , , , <br /> 10 $0 4 20 40 4 - <br /> 22,6 25 5 25 50 s <br /> Is s0 6 so 60 6 <br /> i7,s 95 7 85 70 7 <br /> 20 40 8 AO 80 8 ' <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 962051 T 209 468-34201 F 209 464-0138.1 www.sicehd.com <br />