Laserfiche WebLink
3AIVSJUAQUII1 Environmental Health Department <br /> —COUNTY— <br /> Greatness grows lie) <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: ! 11V Inspector:Jai ,/to CONSTRUCTION <br /> Facility Address: (.30 <br /> Well Address: Total Depth: <br /> WP# 00390V Well#: Drilling Rig Type: <br /> Soil Boring#: NAL, Vtv%-3 Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: <br /> Filter Pack From: To: <br /> Geologist: (C— 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 �zsing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND , <br /> COMPLE 80 I <br /> ta <br /> Holding Temperature: Co.hPLETIoN ct�apt�rio <br /> Method: [=rASulace <br /> Screening Method: gr <br /> Verified Chain of Custody: ❑ Yes ❑No n' <br /> ft- <br /> SPOILS SPOILS = _ <br /> 4 — __ <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: sr <br /> Covered: ❑Yes ❑No . <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 2 1 <br /> Depth to Water: —fL F _ IF L <br /> Grout Material: CeA,4.i, MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation OWell Destruction Blank Feet Screen Feet <br /> ❑Borin Installation ,,_.,,// Slot Size: <br /> g L"JBoring Destruction gags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest 4Bags Thickest Thinnest >tBags Bentonite/Cement Mix 3°,rfo Mix 5% Mix_ <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10' 2 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 15 30 3 <br /> 10 I 1 i I <br /> 12.5 25 5 25 50 5 — � � -7 <br /> 15 30 6 30 60 6 d__ <br /> 17.5 35 7 35 70 7 `'lT <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T' 209 468-34201 F 209 464-0138 1 www.sicehd.com <br />