Laserfiche WebLink
SAN JOAQUIN <br />-----COU NTY-- <br />`�r,,'�aN`�' Greatness grows here. <br />Environmental Health Department <br />Monitoring Well/Soil Boring Inspection Report <br />Date: '41-2-q 12 t Inspector:CA If)103 CONSTRUCTION <br />Facility Address: O 5• U I ✓L <br />Well Address: Total Depth: <br />WP# cx)'O Well#: Drilling Rig Type: <br />Soil Boring#: <br />Drilling Company: l�tSl'a'u Min 2" Annular EHD Seal Verified: <br />❑ Yes ❑No <br />Driller Onsite: <br />Screen Length <br />From: <br />To: <br />Consultant: <br />rg iY . Filter Pack <br />From: <br />To: <br />Geologist: <br />Bentonite <br />From: <br />To: <br />s 10 <br />Grout <br />From: <br />To: <br />Public Water System Onsite: ❑ Yes <br />El No COMPLETION <br />❑ Stove Pipe <br />❑Christie Box <br />Domestic Well Onsite: ❑ Yes L1 No <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 />If yes, material: <br />1 <br />GROUTING or DESTRUCTION Total Depth:i <br />Depth to Water: <br />Grout Material: <br />casing <br />height <br />ABOVE -GROUND CHRISTY43OX <br />COMPLETION COMPLETION <br />Ground Surf=* <br />grout <br />tt. <br />tt. <br />= o <br />Wound <br />sacton '— <br />tt.L== tt. <br />Gallons of Grout Used:MATERIALS/DEVELOPMENT <br />Casing Type: <br />[]Well Installation ❑ t cti <br />Well Deson Blank Feet <br />El Boring Installation Moring Destruction <br />METHOD USED <br />❑Pressure Grout ❑Over Drill <br />❑ Gravity IaTremie ❑Other: _ <br />Water <br />allons I <br />ement 471b <br />Bas <br />Water <br />vallons <br />Cement 941b <br />Bags <br />Thickest Thinnest <br />Thickest Thinnest <br />#Bags <br />2.5 5 <br />1 <br />5 10 <br />1 <br />s 10 <br />2 <br />10 20 <br />2 <br />7.5 15 <br />3 <br />15 30 <br />3 <br />10 20 <br />4 <br />20 40 <br />4 <br />12.5 25 <br />5 <br />25 50 <br />5 <br />15 30 <br />6 <br />30 60 <br />6 <br />17.5 35 <br />7 <br />35 70 <br />7 <br />20 40 <br />8 <br />40 80 <br />8 <br />Slot Size: <br />Bags of Cement: <br />Bags Sand/Gravel: <br />Type/Brand of Bentonite: _ <br />Filter Pack Type/Size: <br />Type of Method: <br />Screen Feet <br />Bentonite/Gement Mix 3% M W47 <br />Bentonite per 47 Ib 1.41 <br />Bentonite per 94 Ib 2.82 <br />10/16/2017 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sacehd.com <br />