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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> — <br /> Monitoring <br /> t'oring Well/Soil Boring Inspection Report <br /> Date: Inspector: W CONSTRUCTION I <br /> Facility Address: 3 L}"3 <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: S� <br /> Soil Boring#: ` 2 L-4' S '65c <br /> Drilling Company: n 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: ,� �j2 l0 Screen Length From: To: <br /> Consultant: r�Z,...� Filter Pack From: To: <br /> Geologist: � $? , Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes El No LD COMPLETION El 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: COWLEMN COMPt..EMN <br /> Method: Ground Surlacs <br /> Screening Method: grout <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 /> wcson '— <br /> Covered: ❑ Yes ❑No <br /> If yes, material: F <br /> GROUTING or DESTRUCTION Total Depth: 's t` +6 <br /> IF <br /> Depth to Water: t ft <br /> Grout Material: ���' C <br /> Gallons of Grout Used: 2, gGlJ,r„� ��, © 54 I_ MATERIALS/DEVELOPMENT <br /> �'°'1} Casing Type: <br /> ❑Well Installation ❑Well Destruction C� > Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Prsure�Grout ❑gier�DDrill Filter Pack Type/Size: <br /> Grav tlYP �Tremie JJ ❑Other: Type of Method: <br /> Water Cement 471b water Cement 941b <br /> allons Bas Rallons Bags <br /> Thickest Thinnest 11 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 <br /> 12.5 25 25 50 5 /�� `/fAA <br /> 15 30 6 30 60 6 n <br /> 17.5 35 7 35 70 7 <br /> 20 40 B 40 80 8 ^ <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-34 11 F 2h9' 6 0138 1 ww.sicehd.com <br />