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i <br /> SANaJOAQUIN <br /> Environmental Health Department <br /> —COUNTY— <br /> Ss;,,.;-j�`' Greatness grows here. <br /> Monitoring Well/Soil Boring Inspection Report <br /> 2 G 1 <br /> Date: 1 Inspector: �Ia,5, CONSTRUCTION <br /> Facility Address: <br /> Well Address: Total Depth: <br /> WP# Oil Well#: Drilling Rig Type: <br /> Soil Boring#: IU borl/W5 in Drilling Com Min 2"Annular EHD Seal Verified: El Yes El No <br /> pany Briltei-OTTS e: Tu P r (xD aS(l/2 "5D2ci<i I i, Green Length From: To: <br /> Len <br /> Consultant: lamt ilter Pack From: To: <br /> Geologist: 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 ONO —� casing <br /> If yes, location and distance: height <br /> SAMPLING AaGoG yE dpgmp <br /> Gtffi OX <br /> Holding Temperature: COMPLETION MPl.>:Tiurri cooN <br /> Method: Grotinasaran— — <br /> Screening Method: grout <br /> Verified Chain of Custody: ❑ Yes ❑No ft. <br /> ft. <br /> SPOILS �ft. <br /> _ a <br /> Contamination Noted: ❑ Yes ❑No fi = <br /> If yes,spoils storage Location: awrcad _ s <br /> = B <br /> Covered: ❑ Yes ❑No aiCJoIsc graval Pack <br /> If yes, material: <br /> GROUTING or-DESTRUCTION Total Depth: _ . <br /> Depth to Water: ft ft• <br /> Grout Material: <br /> Gallons of Grout Used: U MATERIALS/DEVELOPMENT <br /> Casing Type: <br /> ❑Well Installation Well Destruction Blank Feet Screen Feet <br /> ❑Boring Installation JKBoring Destruction Slot Size: <br /> Bags of Cement: <br /> METHOD USED Bags Sand/Gravel: <br /> Type/Brand of Bentonite: <br /> ❑Pressure Grout Dover Drill Filter Pack Type/Size: <br /> ❑ Gravity 01remie ❑Other: Type of Method: <br /> Water Cement 471b Water Cement 941b <br /> allons Bags gallons Bags <br /> Thickest Thinnest kBags Thickest Thinnest psags BantOnttelGeroent MIX 3°/a MIX 5%MiX <br /> 2.5 5 1 5 10 1 Bentonite per 47 lb 1.47 2.47 <br /> 5 10 2 10 20 2 Bentonite per 94111 2.62 4.7 <br /> 7.5 15 3 15 30 3 , 1 <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. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sicehd.com <br />