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12-° ct SANJOAQUIN <br /> !a� k'K *1covNTY Environmental Health Department <br /> Greatnass grows (fere. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: 2 �3lot Inspector: P)( —0 = CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP#00 2L0�5 Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: Min 2"Annular EHD Seal Verified: ElYes ❑No <br /> Driller Onsite: slex4ej TQ Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: i-mQ 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 �asg <br /> If yes, location and distance: halght <br /> SAMPLING 0 W_ _]p <br /> mA � , E �D <br /> r Holding Temperature: CO&PLE N COWLsnON <br /> Method: Grum 8ufxs <br /> Screening Method: groat <br /> Verified Chain of Custody: ❑Yes El No fL <br /> Ite <br /> fL <br /> SPOILS t I A <br /> Contamination Noted: ❑Yes ❑No '= <br /> If yes,spoils storage Location: <br /> Covered: ❑Yes ❑No ter, <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: I _ <br /> Depth to Water: M <br /> Grout Material: . <br /> Gallons of Grout Used: - MATERIALS/DEVELOPMENT- <br /> G�� singType: <br /> ❑Well installation ❑Well.Destruction ti `I ` dank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation oring Destruction Bags Size: <br /> Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑Gravity E)emie ❑Other: Type of Method: <br /> Water cement 4710 Water Cement 94 lb <br /> allons Bags allon5 Bags <br /> Thickest Thinnest wags Thickest Thinnest 'Bags BentonitefCement Mix 3°f°Mix 3°f°Mix <br /> 2.s s 1 s 10 1 _E3entonite per 47 lb 1.41 2.47 <br /> s l0 2 495 <br /> 20 2 Bentonite per 94!b 2.82 4.`I <br /> 7.5 15 3 30 3 <br /> s c <br /> 10 20 4 40 4 <br /> 12.5 25 5 50 5 <br /> 15 30 6 60. 6 <br /> 17.5 35 7 70 7 <br /> 20 40 8 40 80 1 8 <br /> 10/16/2017 <br /> 1358 E Hazelton Aldan ue) Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 ww%v.sicehd.com <br />