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(tSAN JOAQUIN Environmental Health Department <br /> ' COUNTY <br /> `. <br /> Greatness grows here. <br /> rf <br /> JI nn / <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date:q I v 1 Inspector:—00--l"0-1' 10'-- CONSTRUCTION <br /> Facility Address: 'a(,S C e ; h . <br /> Well Address: Total Depth: „ •' <br /> WP# o F) ';q q Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drilling Company: q ;i ; Min 2" Annular EHD Seal Verified: El Yes El No <br /> Driller Onsite: i-ock;Q Screen Length From: To: <br /> Consultant: /- i"0 t' <br /> Filter Pack From: To: <br /> Geologist:_ A �jr�u� 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 /> ITTLT T <br /> SAMPLING ABOVE-GROUND C_ <br /> _ <br /> Holding Temperature: COMPLETION <br /> OPLETION <br /> M <br /> Method: Ground Surface <br /> Screening Method: M <br /> grout <br /> Wd <br /> Verified Chain of Custody: ❑ Yes El No <br /> H. <br /> ft. <br /> SPOILS <br /> a = e <br /> Contamination Noted: ❑ Yes El No a` <br /> If yes, spoils storage Location: slatted = d <br /> aKJon <br /> Covered: ❑ Yes El No =' <br /> ..� = pnwt pack <br /> If yes, material: Ir h <br /> GROUTING or DESTRUCTION Total Dep h:�5 T� 3� t�� �) <br /> Depth to Water: - Ho �U/ tL " tt' <br /> Grout Material:_ la 'f <br /> MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: `-1 Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation iSBoring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill <br /> Filter Pack Type/Size: <br /> Gravity 17Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas - eallons Bags <br /> Thickest Thinnest ttBags Thickest Thinnest pBags 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 5 25 50 5 <br /> 15 6 30 60 6 <br /> 17.5 35 ; 7 ! 35 70 7 <br /> 20 8 40 80 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />