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Q AQ_ Com\ SAN :J OAQ U I N Environmental Health Department <br /> Q1 —COUNTY— <br /> ,` . ���... <br /> c9uFaa�� Greatness grows here. <br /> rr f iq Monitoring Well/Soil Boring Inspection Report <br /> Date: I Z�I I I Inspector: SwL �� CONSTRUCTION <br /> Facility Address: _b I Vv 67S UGywQ- <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: _� 4 gL <br /> Drilling Company: � ��{' �OGI,l�' Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Screen Length From: To: <br /> Driller Onsite: <br /> Filter Pack From: To: <br /> Consultant: <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 El No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: COMPLETION COMPLETION <br /> Method: Ground Surf"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS <br /> o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes,spoils storage Location: <br /> Covered: ElYes El No aac5on <br /> s = B <br /> = gnva Pads <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: Z _ <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> El Boring Installation rABoring 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 941b <br /> Rall! s Bas aallons Bags <br /> Thickest Thinnest gBags Thickest Thinnest uBags 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 /> 1 20 4 20 40 4 <br /> 12..5 25 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 125 s 40 eo a0 40 Z b 71J <br /> aA <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 />