Laserfiche WebLink
SAN J OAQ U I N Environmental Health Department <br /> COUNTY <br /> c ciF ,4 aE Greobness grows here . <br /> Monitoring Well / Soil Boring Inspection Report <br /> Date : Inspector . CONSTRUCTION <br /> Facility Address : gr X640 � �a•z �y � �' <br /> Well Address : Total Depth : <br /> WP # Oa '�// 7 / / Well # : Drilling Rig Type . <br /> Soil Boring# : rdP— ' 0 <br /> Drilling Company : CC2sc � Min 2 " Annular EHD Seal Verified : El Yes ❑ No <br /> : 1'�vl- Screen Length From : To : <br /> Driller Onsite <br /> Consultant : Filter Pack From : To : <br /> Geologist : � 4 & / AtBentonite From : To . <br /> Grout From : To . <br /> Public Water System Onsite : ❑ Yes El No COMPLETION ❑ Stove Pipe ❑ Christie Box <br /> Domestic Well Onsite : ❑ Yes El No casing <br /> If yes , location and distance : height <br /> SAMPLING ABOyE..OROUNo __ <br /> Holding Temperature : COWLE• lON COMPLEMN <br /> Method : G= rd Surface <br /> Screening Method : grout <br /> Verified Chain of Custody : ❑ Yes ❑ No wre ft• <br /> tt . <br /> ft . 4000 dodommom <br /> SPOILS = <br /> Contamination Noted : ❑ Yes ❑ No — <br /> If yes , spoils storage Location : : <br /> soon <br /> Covered : ❑ Yes ❑ No -: = t <br /> ack <br /> If yes , material : ,;.. <br /> GROUTING or DESTRUCTION Total Depth . _ <br /> Depth to Water . ft• — ft• <br /> Grout Material : i MATERIALS DEVELOPMENT <br /> Gallons of Grout Used . Sr cs/ktr <br /> Ge Casing Type : <br /> ❑ Well Installation ❑]Well Destruction Blank Feet Screen Feet <br /> ❑ Boring Installation LJBoring Destruction Slot Size : <br /> Bags of Cement : <br /> METHOD USED Bags Sand / Gravel : <br /> Type/ Brand of Bentonite : <br /> ❑ Pressure Grout ❑ Over Drill <br /> Filter Pack Type/Size : <br /> ❑ Gravity I ITremie ❑ Other : Type of Method : <br /> V1i er Cement 471b Water Cement 941b <br /> allon Bas pzallons Bags <br /> Thickest Thinnest # Bags Thickest Thinnest Bags Bentonite/ Cement Mix 3 % Mix 5 % Mix <br /> 2 , 5 5 5 10 1 Bentonite per 47 Ib 1 .41 2 .47 <br /> 5 10 2 10 20 2 Bentonite per 94 Ib 2082 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 30 60 6 <br /> 17. 5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 44/,03 10/ 16/ 2017 <br /> 1868 E . Hazelton Avenue Stockton , California 95205 T 209 468 - 3420 1 F 209 464- 0138 1 www . sicehd . com <br />