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SAN JOAQUIN Environmental Health Department <br /> —COU NTY---- <br /> C�reui.ness <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: • 1 02 Inspector: L i ` b CONSTRUCTION <br /> Facility Address: 6ra4t <br /> Well Address: 1 d Total Depth: <br /> WP# 17,3$ Well#: Drilling Rig Type: <br /> Soil Boring#: a 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: c{,, q 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: WT <br /> heigint <br /> SAMPLING A-ROVE-GROUND <br /> Holding Temperature: OCIMP'EMN COt���oN <br /> Method: CarmjndSLrfacs "+ <br /> Screening Method: or«n <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No — <br /> If yes, spoils storage Location: <br /> Covered: ❑ Yes ❑No <br /> If yes, material: p� <br /> GROUTING or DESTRUCTION Total Depth: luo = <br /> Depth to Water: lbft — ft <br /> Grout Material C WI AL/6, MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation VBoring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 11) <br /> allons Bass Rall is Baas <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 05 <br /> lz.s zs s 25 so s q/10" �� � <br /> 1s 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 0 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />