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2' SAN JOQQUIN Environmental Health Department <br /> COUNTY-- <br /> °qr 5' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:�It f 11 Inspector: L.V- CONSTRUCTION <br /> Facility Address: o ° <br /> Well Address: Total Depth: <br /> WP#_ -Well#: Drilling Rig Type: <br /> Soil Boring#: � 47- . Q Cl 4q <br /> Min 2„ Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: V <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: `G.(�,,,,n „� <br /> Filter Pack From: To: <br /> Geologist: A_01wr 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 1:1 No •--� casing <br /> If yes, location and distance: I height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COWPLETION COMPLEMN <br /> Method: G=nd Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft' <br /> n. <br /> n. <br /> SPOILS a <br /> e1. <br /> Contamination Noted: ❑ Yes 1:1 No = <br /> If yes,spoils storage Location: stotiQd _ B <br /> &aeon <br /> Covered: ❑ Yes ❑No = f <br /> ack <br /> If yes, material: r <br /> GROUTING or DESTRUCTION Total Depth:_I ,S <br /> Depth to Water: D tt. ft. <br /> Grout Material: A.,e '941_� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used^- D �Z.o ti-bD� <br /> )i' -"� Casing Type: <br /> ❑Well Installation ❑WWe�ell Destruction Blank Feet Screen Feet <br /> []Boring Installation Pll oring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> W- <br /> Filter Pack Type/Size: <br /> I�Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas aallons Bags <br /> Thickest Thinnest 11 Bags Thickest Thinnest sBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 s 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 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 /> lz.s 1 zs s 25 so s <br /> 15 1 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 80 s LA1 V� ZZ Id L v I I B lye t <br /> d <br /> 2 10/16/2017 <br /> `''� �,� 6n S hq I�,� <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0 '38 www.sicehd.com <br />