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i PQUIY.. <br /> SANJOAQUIN <br /> Environmental Health Department <br /> WTD —COUNTY <br /> �9�;FoaN Greatness grows her,. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: �°` Inspector: _ CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# Well#: Drilling Rig Type: <br /> Soil Boring#: Min 2" Annular EHD Seal Verified: ❑ Yes El No <br /> Drilling Company: <br /> Driller Onsite: Q-��`{ �- � ��,'���_ Screen Length From: To: <br /> Consultant: Filter Pack From: To: <br /> Geologist: Bentonite From: To: <br /> Grout From: To: <br /> Public Water System Onsite: ❑ Yes AN <br /> oCOMPLETION ❑ Stove Pipe ❑Christie Box <br /> Wooo ('v-" w��� <br /> Domestic Well Onsite: X Yes ❑No casing <br /> If yes, location and distance: `Qt--typ o'4LZ � height <br /> SAMPLING <br /> ABOVE-GROUND C4iR TY Box <br /> Holding Temperature: COMPLETION comPLEnoN <br /> Method: Ground Sudx. '+ <br /> Screening Method: grout <br /> 1 <br /> Verified Chain of Custody: ❑ Yes El No <br /> tt. <br /> SPOILS T <br /> Contamination Noted: ❑ Yes ❑No <br /> If yes, spoils storage Location: <br /> X—tQd <br /> s�^cn <br /> Covered: ❑ Yes ❑No <br /> EE <br /> If yes, material: h, <br /> GROUTING oTotal Depth: (,-to =_ . <br /> Depth to Water: n — tt <br /> Grout Material: NOVA � <br /> s Gallons of Grout Used: MATERIALS DEVELOPMENT <br /> Casing Type: <br /> ❑Well InstallationW ell Destruction Blank Feet Screen Feet <br /> Slot Size: <br /> ❑Boring Installation ❑Boring Destruction 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 VTremie ❑Other: Type of Method: <br /> Water Cement 471b ;Vater Cement 941b <br /> ailons 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 25 3 15 I 30 3 <br /> 10 20 4 20 40 4 <br /> 12.5 25 5 25 50 5 <br /> 15 1 30 6 30 60 6 <br /> 17.5 1 35 7 35 70 7 <br /> 20 1 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 />