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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY— <br /> Greetness orow.s her-. <br /> �q <br /> Monitoring Well/Soil Boring Inspection Report <br /> / <br /> Date: ! 0< ` / _ Ins ector: l.� ' CONSTRUCTION <br /> Facility Address: 2�-► e� U���� <br /> 3 =� <br /> Well Address: Total Depth: 12,1 <br /> p _y��^ <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: C,4 �4—r <br /> Drilling Company: 01c Min 2" Annular EHD Seal Verified: �4 ❑No <br /> Driller Onsite: Screen Length From: 3�3 To: 2 O <br /> Consultant: Filter Pack From: 355 To: � fj <br /> Geologist: Bentonite From: jdTo: <br /> Grout From: To: (� <br /> Public Water System Onsite: ❑ Yes 11 No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: WT <br /> height <br /> � <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: CoMPLEflON COMPLETioN <br /> Method: G=nd Surf"''" <br /> Screening Method: or <br /> Verified Chain of Custody: El Yes El No10 ft' <br /> 1. fi. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No r = r <br /> If yes, spoils storage Location: sbtto� <br /> s+c:on <br /> Covered: ❑ Yes ❑No <br /> g-4 Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:' <br /> Depth to Water: 0 <br /> Grout Material: r <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> *ell <br /> Casing Type: <br /> Installation ❑Well Destruction Blank Feet Screen Slot Size: <br /> ❑Boring Installation ❑Boring Destruction 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 /> r ❑ Gravity �emie ❑Other: Type of Method: <br /> water Cement 471b Water Cement 941b <br /> allons Bas gallons Bags <br /> Thickest Thinnest uBags Thickest Thinnest 4Bags Bentonite/Cement Mix 3% Mix a% MIX <br /> 2.5 5 1 5 10 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 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/ 6/ 7 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-01 8 1 www.sicehd.com <br />