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SANJOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: `100 10 - <br /> Well <br /> J -Well Address: Total Depth: <br /> WP# `\-UD . Well#: Drilling Rig Type: <br /> Soil Boring#: <br /> Drillin Com an Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> g p Y:�2&&-Aa„ <br /> Driller Onsite: Screen Length From: To: <br /> Consultant: `��-_`4�kx <br /> Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ZYes ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes �No casing <br /> If yes, location and distance: height <br /> SAMPLING AWVE-GROUND <br /> Holding Temperature: COMPLET)ON COMPcN <br /> Method: G=nd Sumacs <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft.ft. <br /> ft. <br /> SPOILS <br /> = o <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: sbttoa <br /> ssc�on — —" <br /> Covered: ❑ Yes ❑No <br /> g-w1W pack <br /> If yes, material: .= _ <br /> GROUTING or DESTRUCTION Total Depth: '�j� • =_ <br /> Depth to Water: moo' fL ft' <br /> Grout Material:_ �2 jr�/ s,� MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well Installation OWell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> El Pressure Grout llOver 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 #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 5 25 50 5 <br /> 15 30 6 30 60 6 <br /> 17.5 U 7 35 70 7 <br /> 20 9,01 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 />