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SAN JOAQUIN <br /> N Environmental Health Department <br /> —COUNTY-- <br /> 'LIFO <br /> OUNTY -'LI P/ Greatness grows here. <br /> j1q <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: r o CONSTRUCTION <br /> Facility Address: <br /> Well Address: 2�j;2a IC Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: La <br /> Screen Length From: To: <br /> Driller Onsite: <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 ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING ABOVE-GROLWO <br /> Holding Temperature: COWPLETION cCMPLEnoN <br /> Method: around Surfact <br /> Screening Method: or�- <br /> Verified Chain of Custody: El Yes El No M <br /> tt. <br /> tt. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: '' <br /> s <br /> abtt+d c <br /> sacdon <br /> Covered: ❑ Yes ❑No <br /> If yes, material: II <br /> GROUTING or DESTRUCTION Total Depth:�� �t . =_ <br /> Depth to Water: n' <br /> Grout Material: f\hDyt r MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: ��c�(�qc-, <br /> Casing Type: <br /> �jWell Installation ❑Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation ❑Boring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout ❑Over Drill Filter Pack Type/Size: <br /> ❑ Gravity I$Tremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bas izallons 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 35 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 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 />