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2 z SA N J OAQ U I N Environmental Health Department <br /> COU NTY— <br /> ��u�_ �/, Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: 1�+ CONSTRUCTION <br /> Facility Address': '31Uc� D 10-r"40 S �. <br /> Well Address: Total Depth: <br /> WP# � ©1 ()I ?�-) Well#: Drilling Rig Type: <br /> Soil Boring#: 1�UJ 11� Min 2" Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company:_ /� t Driller Onsite: Screen Length From: To: <br /> TDB <br /> Consultant: i✓bv1!V`P.i'J4 <br /> Filter Pack From: To: <br /> Geologist: �56( 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: WT <br /> height <br /> SAMPLING ABOVE-GROUND <br /> Holding Temperature: OOWPLETfON COMPL MN <br /> Method: Ground Surface <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes El No �ft. <br /> ft. <br /> ft. <br /> SPOILS = <br /> — m <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: sbnad <br /> aeon = B <br /> Covered: ❑ Yes El No <br /> gra-4 Pack <br /> If yes, material: ^x <br /> GROUTING or DESTRUCTION Total Depth: <br /> Depth to Water: <br /> Grout Material: MATERIALS/DEVELOPMENT <br /> Gallons of Grout Used: <br /> Casing Type: <br /> ❑Well 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 /> ❑Pressure Grout ❑Over Drill Type/Brand of Bentonite: <br /> Filter Pack Type/Size: <br /> ❑ Gravity ❑Tremie ❑Other: Type of Method: <br /> Water Ce nt 4716 Water Cement 941b <br /> gall s a eallons Bags <br /> Thickest Thinnest sBags Thickest Thinnest NBags Bentonite/Cement Mix 3% Mix 5% Mix <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.41 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94 lb 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 8 1 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 />