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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: I-,Qspe1,,otr:��/I A i�1y��o— CONSTRUCTION <br /> Facility Address: 'S �J� <br /> Well Address: Total Depth: <br /> WP# () D 3 Well#: Drilling Rig Type: <br /> Soil Boring#: 93 <br /> Drilling Compan�C � Wi�2bl" G Min 2" Annular EHD Seal Verified: El Yes ❑No <br /> Driller Onsite: 1—✓ Screen Length From: To: <br /> Consultant: ?tet h Filter Pack From: To: <br /> Geologist: I/Vy 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-GROUND <br /> Holding Temperature: conF�TION noN <br /> Method: Ground Surface <br /> Screening Method: eZll grout <br /> Verified Chain of Custody: ❑ Yes ❑No <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No a� _ <br /> If yes, spoils storage Location: atotzae <br /> asc9on <br /> Covered: ❑ Yes ❑No =' <br /> = ar��pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: SQ :t. __ <br /> Depth to Water: l n- <br /> Grout Material: //Qac <br /> Gallons of Grout Used: (Qq.-,( MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation ❑Well Destruction Blank Feet Screen Feet <br /> Size: <br /> ❑Boring Installation YBoring Destruction Bags Slot Siziz 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 941b <br /> allons Bag gaI1111 ons 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 35 7 35 70 7 <br /> 20 40 840 80 8 <br /> (� (� 10/16/2017 <br /> 1-�s 9C-1 ' t I g bey <br /> 1868 E. Hazelton Avenue I /Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 1 www.sicehd.com <br />