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SAN OAQUIN <br /> !•'•!r. —COUNTY Environmental Health Department <br /> Greatness yrows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: inspector: }'1�( �fll CONSTRUCTION <br /> Facility Address: <br /> Well Add s: �( � Total Depth: <br /> WP#Add <br /> Well#: G Drilling Rig Type: <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: Q � lal7i1� 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 ❑No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes ❑No casing <br /> If yes, location and distance: height <br /> SAMPLING nsove.dROUND <br /> � 1ON Holding Temperature: COWLEE-MN <br /> Method: Ground S"rf"' <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No --n' <br /> tt. <br /> ft. <br /> SPOILS <br /> Contamination Noted: ❑ Yes El No <br /> kC <br /> If yes,spoils storage Location: atoned <br /> aic.on <br /> Covered: ❑ Yes ❑No <br /> g-vw Pack <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: . <br /> Depth to Water: <br /> Grout Material: �' v�I�r�I� <br /> Gallons of Grout Used: MATERIALS DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Nell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction Bags iz Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> L7Pressure Grout *ver Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity LUremie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> Pail Bags e allons Bags <br /> Thickest Thinnest 9Bags Thickest Thinnest 9Bags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 Ib 1.411 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 1 2.821 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 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 />