Laserfiche WebLink
' <br /> ' IQ i; <br /> �8KJ|�&HU|N <br /> `�}�|���W8UU��� <br /> Environmental Health ���� �0� <br /> ' ---[{}UNTY-- HeaDepartment� <br /> Greotne5^ nmxn here. <br /> h8On'fOr'Dg VVe|USo'| Boring |DspeCƒ'OD Report <br /> Date:. Inspector: CONSTRUCTION <br /> Facility Address:_ <br /> Well Add Total Depth: <br /> VVP eU#: Drilling Rig Type: <br /> SoUBoring#: <br /> Min Z"Annular EHDSeal Verified: El Yes []No <br /> Driller Onsite: Screen Length From: Tn:__________ <br /> Filter From: �To <br /> Consultant: �------ `---------' <br /> Geologist: Bentonite From: To:_________ <br /> Grout Frnm: To:- <br /> Public Water System Onsite: <br /> o:__________Pub|icVVaterSystemOnsite: [] Yes []Nu COMPLETION [] Stove Pipe []ChristieBox <br /> Domestic Well Onsite: [] Yes []No <br /> casing <br /> |fyes,location and distance: heightSAMPLING <br /> ABOVE-GROUND . <br /> Holding Temperature: 000�"u�n�m COMFLEFrioN <br /> ~^--'^ <br /> Method: cmd=d Sun=* <br /> Screening Method: grout <br /> Verified Chain ofCustody: L] Yes L1 No ' <br /> ' <br /> SPOILS <br /> Contamination Noted: [] Yes []No <br /> |fyes,spoils storage Location: <br /> Covered: [] Yes []No � <br /> /fyes, material: <br /> GROUTING or DESTRUCTION Total Depth: __����_ <br /> Depth toWater: -n, <br /> Grout Material: <br /> Gallons ofGrout Used: <br /> Casing Type: <br /> �x <br /> LJVVe|| |nsta||ation �1VVe|| Destruction Blank Feet Screen Feet <br /> []Boring/nstaUation []BuhngDestruction Slot Size: <br /> Bags ufCement: <br /> METHOD USED 8a0sSan6/Grave|: <br /> []PreoureGrout []0verDri|| Type/Brand ofBentonite: <br /> Filter Pack Type/Size: <br /> []Gravity �rtremie lw~thec Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> aallan5 Bags gallons Bags <br /> Thickest T-hi-nnest 9 Bags Thickest Thinn-est Bags Bentonite/Cement Mix 3%-Mix 50% Mix <br /> 7.5 15 a 15 30 3 8entonite per 94 lb 2.82 —4.7 <br /> 10 20 4 20 40 4 <br /> 15 30 6 30 60 6 <br /> l0/16/IU17 <br /> 1888E. Hazelton Avenue Stockton, California QS2051 T 200488'342O1 F 208484'U138 1 <br />