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SAN JOAQUIN <br /> Environmental Health Department <br /> COUNTY— <br /> °`croa Greatness gro:,c i,=r <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: L-I✓ 4 CONSTRUCTION <br /> Facility Address: t06" 0 <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Company:_ Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Drilling ew�Jl�,���rr s ,�,,,c Screen Length From: To: <br /> Driller Onsite: Zr,�� . M.A.A'r <br /> Filter Pack From: To: <br /> Consultant: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COhF ION CC61PLEnOON <br /> Method: G=nd SLeacs'+ <br /> Screening Method: ar«n <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> ft. <br /> SPOILS = <br /> 1:J <br /> Contamination Noted: ❑ Yes ❑No = <br /> If yes, spoils storage Location: slotted <br /> sataon <br /> Covered: ❑ Yes ❑Noro-val Pack <br /> _ <br /> If yes, material: = _ <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: IF <br /> n' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> M- <br /> Casing Type: <br /> C7Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> �,���� Filter Pack Type/Size: <br /> El Gravity EiW-femie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas Rallifans Bags <br /> Thickest Thinnest 4Bags 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 /> 5 0 5 Ll I <br /> 12.5 25 25 5 � (`^�J <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />