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°zl SANJOAQUIN <br /> Environmental Health Department <br /> COU NTY— <br /> °scr n?`� G'eatness grows her,-. <br /> Monitoring Well/Soil Boring Inspection Report <br /> Date: Inspector: CONSTRUCTION <br /> Facility Address: <br /> Well Address: �'��1`3 W"c��,SO� v3v%� Total Depth: LS �t <br /> WP# 'J`Zq Well#: ,— 1D Drilling Rig Type: rcOX141NA— <br /> Soil Boring#: Min 2"Annular EHD Seal Verified: ❑ Yes ❑No <br /> Drilling Company: SR&&g�N 'pcty ro,,nQ, yp <br /> Driller Onsite: 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 C No COMPLETION ❑ Stove Pipe ❑Christie Box <br /> Domestic Well Onsite: ❑ Yes (,No casing <br /> If yes, location and distance: height ir <br /> SAMPLINGAscvEGaounto V' T <br /> Holding Temperature: COMPLETION c��-Hera <br /> Method: Gnxtrid Sidle' <br /> Screening Method: plod <br /> Verified Chain of Custody: ❑ Yes El No <br /> t. <br /> SPOILS <br /> Contamination Noted: ❑ Yes ❑No _ <br /> If yes,spoils storage Location: <br /> Covered: ❑ Yes ❑No <br /> If yes, material: <br /> GROUTING or DESTRUCTION Total Depth: 4. <br /> Depth to Water: ft <br /> Grout Material: <br /> Gallons of Grout Used: MATERIALS/DEVELOPMENT <br /> Casing Type: lV/a <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 Cement 471b Water Cement 941b <br /> gallons Bas gallons Bags <br /> Thickest Thinnest :1 Bags Thickest Thinnest VBags Bentonite/Cement Mix 3% Mix 3%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 I 60 6 <br /> 17.5 35 7 35 70 7 <br /> 20 40 8 1 40 80 1 8 <br /> 10/16/2017 <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 1 F 209 464-0138 www.sicehd.com <br />