Laserfiche WebLink
1 <br /> SAN�JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> Greatness <br /> COU NTY— <br /> �s,;t��t Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �kkA Inspector: K.SQe�ern CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: g1� <br /> WP# W JAL<1 Well#: Drilling Rig Type: mlYL ccLyar\�! <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: cc y-sti r We\I 1 11; <br /> Driller Onsite: 12(NfCtC\ Screen Length From: To: <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑Yes ❑No COMPLETION NfStove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING AWyE-dROUNo —"-Box <br /> Holding Temperature: coNOLETION COMPLETiou <br /> Method: [i=na SLwf=o <br /> Screening Method: <br /> 1 <br /> Verified Chain of Custody: ❑ Yes El No fL <br /> ft. <br /> SPOILS <br /> _ a <br /> Contamination Noted: ❑ Yes ❑No r <br /> If yes, spoils storage Location: xstoned <br /> aac,on = 3 <br /> Covered: ❑Yes ❑No <br /> ', grs„,ol pac3c <br /> If yes, material: — <br /> GROUTING or DESTRUCTION Total Depth: 2CIA' , <br /> Depth to Water: i41 'r <br /> Grout Material: '93t7d (_efren <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: �IQst�c <br /> Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑BSlot Size: <br /> oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ITremie ❑Other: Type of Method: a. tc�) c'_-;,()Ayr,(.,V j(- <br /> Water Cement 471b Water cement 94 lb <br /> gall s Bas gall ons Bags <br /> Thickest Thinnest »Bags Thickest Thinnest it Bags Bentonite/Cement Mix 3% Mix 5 MIx_ <br /> 2.5 5 1 5 l0 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 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 30 6 3o 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue 1 Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />