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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> :�crFoa�' Greatness grows here. b+un5 (A-kb- rt� Y I U til <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 6 I Inspector: , rQf_ CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# DO� 916 I Well#: Drilling Rig Type: <br /> Soil Boring#: Q <br /> Drilling Company: Tu�Xj U'.1 Min 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: ` j 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 El No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes El No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: 001WILE ON c�o�11LMCy <br /> Method: Ground Sumacs <br /> Screening Method: :h grout <br /> Verified Chain of Custody: 1:1Yes 1:1 No �ft• <br /> ft. <br /> tt. <br /> SPOILS <br /> = o <br /> Contamination Noted: ❑ Yes ❑No — <br /> If yes, spoils storage Location: atone <br /> ascSon <br /> Covered: ❑ Yes 1:1 No <br /> g-VW Pack <br /> If yes, material: % <br /> x = <br /> GROUTING or DESTRUCTION Total Depth: 5(p ftr <br /> Depth to Water: `. k n• n' <br /> Grout Material <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring InstallationNSBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity *Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 94 lb <br /> allons Bas gallons Bags <br /> Thickest Thinnest RBags Thickest Thinnest Bags Bentonite/Cement Mix 3% Mix 3%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 5 25 50 5 <br /> 15 30 6 30 60 6 t l <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 />