Laserfiche WebLink
='uPah, SAN JOAQUIN <br />Environmental Health Department <br />"ir,A f—COUNTY— <br />'\ <br />Greatness grows here. <br />Monitoring Well/Soil Boring Inspection Report <br />Date: IZ Ib Inspector: ioa51 CONSTRUCTION <br />Facility Address: <br />Well Address: <br />Well#: <br />Soil Boring#: <br />Drilling <br />Driller Onsite: <br />Consultant: <br />Geologist: <br />Public Water System Onsite: ❑ Yes El No <br />Domestic Well Onsite: <br />If yes, location and distance: <br />SAMPLING <br />Holding Temperature: <br />Method: <br />Screening Method:_ <br />Verified Chain of Custody: <br />SPOILS <br />Contamination Noted: <br />If yes, spoils storage Location: <br />Covered: <br />❑ Yes ❑No <br />❑ Yes ❑No <br />❑ Yes ❑No <br />n Total Depth: <br />Drilling Rig Type: <br />Min 2" Annular EHD Seal Verified <br />Screen Length <br />Filter Pack <br />Bentonite From: <br />Grout <br />COMPLETION <br />From: <br />•- <br />From: <br />From: <br />❑Stove Pipe <br />helght <br />. <br />MINIMTap SLIA" <br />n. <br />•tottad <br />saclon <br />If yes, material: <br />GROUTING or DESTRUCTION Total De th:_ <br />Depth to Water: 110 i(• n• <br />Grout Material `QY(11 <br />r� <br />❑ Yes ❑No <br />To: <br />To: <br />To: <br />To: <br />❑Christie Box <br />Gallons of Grout Used: MATERIALS/DEVELOPMENT <br />Casing Type: <br />❑Well Installation ❑Well Destruction Blank Feet <br />Scree <br />❑Boring Installation QBoring Destruction Slot Size: <br />. Bags of Cement: <br />METHOD USED � Bags Sand/Gravel: <br />J Type/Brand of Bentonite: _ <br />❑Pressure Grout ❑Over Drill �c��k Filter Pack Type/Size: <br />El <br />Gravity ❑Tremie ❑Other: <br />Water Cement 471b Water Cement 941b <br />allons Bas allons Ba s <br />Thickest Thinnest uBags Thickest Thinnest #Bags <br />2.5 5 1 5 10 1 <br />5 10 2 10 20 2 <br />7.5 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 />Type of Method: <br />Feet <br />Bentonite/Cement Mix <br />3% Mix <br />5% Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />20821 <br />4.7 <br />Type of Method: <br />Feet <br />Bentonite/Cement Mix <br />3% Mix <br />5% Mix <br />Bentonite per 47 Ib <br />1.41 <br />2.47 <br />Bentonite per 94 Ib <br />20821 <br />4.7 <br />10/16/2017 <br />1868 E. Hazelton Avenue � Stockton, California 95205 � T 209 468-3420 I F 209 464-0138 � www.sicehd.com <br />