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SAN-J0AQUIN <br /> Environmental Health ®apartment <br /> COUNTY— <br /> Greatness grams fere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: L.11 CONSTRUCTION T <br /> Facility Address: !q?-6/ <br /> Well Address: Total Depth: <br /> WP#M"A` V Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: ♦ height <br /> SAMPLING ASQY'c-GROUND <br /> C'r4MPL -SOX <br /> Holding Temperature: COIS3r'LE rjoN c3EEcraptu=rioN <br /> Method: Gravnd Swfaca <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No tL <br /> fz. <br /> fi. <br /> SPOILS <br /> 'j _ - a . <br /> Contamination Noted: ElYes ❑No = o <br /> If yes, spoils storage Location: s r i5 <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: _ r <br /> Depth to Water: <br /> Grout Material: (3w.�+wvvlc_ MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout []Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas gallif ons Bags <br /> Thickest Thinnest 4'Bags Thickest Thinnest #Bags Bentonite/Cement Mix 3% Mix 5% 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 J4 0 U -to <br /> � <br /> 15 30 6 30 60 6 V 'V <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 0 <br /> {b G•+•. 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />