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SANIOAQUIN Environmental Health Department <br /> I" '_ COUNTY--. <br /> �cqP, Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 3 Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# pc)3g11k Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Ca..��rx tri! �✓1. (,., <br /> Driller Onsite: ...r..d,., 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 /ABOVE-GROUND <br /> Holding Temperature: COWLETION COOMPLPTION <br /> Method: Ground Surf=* <br /> Screening Method: Vpll cr«d <br /> Verified Chain of Custody: ❑ Yes El No ft. <br /> ft. <br /> ft. <br /> tt. <br /> SPOILS _ <br /> Contamination Noted: ❑ Yes 1:1 No = <br /> If yes, spoils storage Location: ato�d <br /> section <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> x <br /> GROUTING or DESTRUCTION Total Depth: )1(4A =_ <br /> Depth to Water: tt tt' <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> Z;V�Ie-ll Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> 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 /> ❑ Gravity U•T1 emie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest rrBags 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 2 SO(-!p <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 /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />