Laserfiche WebLink
S Q NJ OQQ U S N Environmental Health Department <br /> —COUNTY <br /> Monit'o�ri1ng /W� ell/Soil Boring Inspection Report <br /> Date: 5nspe tor: CONS RUCTION <br /> Facility Address: ► + 4f _i <br /> Well Addmss: Total Depth: `J •� '� <br /> WP# VJ V 00 :5II#: Drilling Rig Type: 61, <br /> W � t <br /> Soil Boring#: f ) <br /> Drilling Company: Min 2"Annular EHD Seal Verified: El Yes ONO <br /> a5 n <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: g�/� Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: cot�'LETION c ON <br /> Method: t3=rd Sumacs <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑ Yes ❑No .fin• <br /> n. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> a{onad <br /> sac;ion <br /> Covered: ❑Yes ❑No = 9-01 <br /> Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 4. <br /> Depth to Water: <br /> Grout Material ri �I�AATERIALS/DEVELOP MENT <br /> Gallons of Grout Used: g <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction , ( P Q Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring InstallationloBoring Destruction kj `tet d` <br /> Bags of Cement: <br /> METHOD USED P'�0 b Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Si Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 47 lb Water Cement 94 lb <br /> gallons Bags gall ons Bags <br /> Thickest Thinnest #Bags Thickest Thinnest 0Bags 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 /> 7.5 15 3 15 30 3 <br /> 10 20 4 1 20 40 1 4 <br /> 12.5 25 5 25 50 5 <br /> 15 1 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 1 40 80 8 <br /> -� <br /> �a C �o -6 �tuj..3 M,t 10/16/2017 <br /> 1868 E.fiazelton Avenue I Stockton, California 95205 1 T 209468-34201 F 209464-0138 www.sicehd.com <br />