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SAN JOA UIN <br /> 2 z Q Environmental Health Department <br /> "• `' COUNTY <br /> °1 04,0 Greatness grows here. <br /> 1�1[qMonitoring Well/Soil Boring Inspection Report <br /> Date Inspector- V` � CONSTRUCTION <br /> Facility 4dress: 1a0O I u M&iA/ <br /> Well Address: Total Depth: <br /> WP# 00'3 a S I Well#: Drilling Rig Type: <br /> Soil Boring#: C —S "`{'� Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Comja : l , <br /> Driller Onsitl <br /> • Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: /14.ed ail Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes 11 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: 006FLEr10N COMPLETION <br /> Method: Ground Surf=* <br /> Screening Method: orovt <br /> Verified Chain of Custody: ElYes EJ No <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ElYes El No <br /> If yes, spoils storage Location: slotted ' _ - <br /> s�e!on <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth:L00 T ��s � <br /> Depth to Water:_ n- IF <br /> tt' <br /> Grout Material: Ale& /1 l <br /> Gallons of Grout Used: 5- a MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation 1%Boring 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 Ceme 471b Water Cement 941b <br /> allons Bas gallons Baits <br /> Thickest Thinnest uBags Thickest Thinnest It Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 s 10 1 Bentonite per 47 Ib 1.41 2.47 <br /> s 10 20 2 Bentonite per 94 Ib 2.82 4.7 <br /> 7.5 15 3 is 30 3 <br /> 10 20 40 4 <br /> 12.5 25 5 25 s0 5 <br /> 15 30 6 30 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 40 80 8 <br /> (. qo� 3 j 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 />